| Objective:Syphilis is a common sexually transmitted disease(STI)caused by Treponema pallidum(TP)infection.syphilis has decreased in the general population over the past 3 decades,however,a resurgence of syphilis infection has been reported in many parts of the world.In China,the prevalence of syphilis has increased from 6.43 per100,000 in 2000 to 32.86 per 100,000 in 2013,with an average annual increase of13.37%.Syphilis prevalence is high in key populations,especially among men who have sex with men(MSM)around the world.A study of MSM in 41 countries throughout the world found that syphilis prevalence was 6.0%between 2016 and 2017.Human immunodeficiency virus(HIV)and TP have the same transmission route and similar risk factors.The infection rate of co-infection of the two is relatively high,and it is widely prevalent in the world.The survey of various provinces and cities in China from 2013 to 2018 showed that the co-infection rate ranged from 9.4%to19.7%.Anti-retroviral therapy(ART)is widely available to people living with HIV.The majority of HIV-infected patients achieve an recovery in CD4~+T cell count and sustained control of plasma HIV viremia after initiation of combined ART.However,there are still some patients who fail to recover to CD4~+T cell counts of 500/ul and/or CD4/CD8 ratio greater than 1.Relevant studies have proved that the co-infection with other pathogens can affect the clinical prognosis of AIDS,such as viral hepatitis C and CMV infectionand.Whether syphilis co-infection also affects the clinical prognosis of AIDS remains to be further studied.This study has evaluated the prevalence and incidence of TP infection in HIV-infected people,and described its socio-demographic characteristics and clinical related information.The effects of TP infection on the recovery of CD4~+T cell count and CD4/CD8 ratio were evaluated,and the effects of complicated TP infection on antiviral treatment failure and death were also analyzed.The results will provide scientific basis for strengthening the management of HIV infected patients with TP and improving the clinical prognosis.Methods:Research object:HIV-infected patients who were followed up in the Care Clinic of the First Affiliated Hospital of China Medical University,from January 2010 to December 2019:HIV antibody positive,≥18 years old,rapid plasma reactive hormone(RPR)test results and Treponemal pallidum particle assy(TPPA)results can be obtained.Laboratory tests:Viral load(VL)was detected by using COBAS Amplipre COBAS Amplicor HIV-1 test,version 2.0(CAP-CA;Roche Molecular Systems,USA),detection limit is 20 copies/ml.CD4~+T cell and CD8~+T cell count were measured using a FACSCalibur flow cytometer(BD Bioscience,California,USA)based on a single platform hemolytic non-wash procedure using Tru COUNT tube and Tri TEST anti-CD4/FITC/CD8/PE/CD3/Per CP reagent(BD Bioscience,USA).Syphilis screening was performed using rapid plasma reagin serological test(kit of Shanghai Kehua Bioengineering Company,China),and syphilis confirmation was carried out by using treponema particle coagulation test(kit of Forbes Rebio Co.,Ltd.).Statistical analysis:Classified variables are reported as percentages,and continuous variables are reported as mean±standard deviation or median and quartile range(IQR).T-test(measurement data)and 2-test(counting data)were used to compare the two samples between groups.We used Cox regression model to adjust for sociodemographic characteristics,such as gender and age,and calculated the adjusted Hazard Ratio(AHR)for achieving immune recovery to failure and 95%confidence interval(CI)of related factors.All statistical analyses were performed using IBM SPSS STATISTICS 23.0.Results:1.A total of 2992 HIV-infected patients were enrolled in the study.The subjects were mainly male,accounting for 93.95%,and mainly young adults,with an average age of 41.21±12.28 years.The prevalence rate of HIV complicated with TP infection from2010 to 2019 was 36.03%,The incidence rate was 4.69cases/100 person-years.The age of patients in the TP positive group was lower than that of TP negative group,and the infection route was mainly male homosexual or bisexual(P<0.001).2.TP positive was an important risk factor affecting the recovery of CD4~+T cell count in HIV infected persons(HR=1.388,95CI(1.048-1.583),P=0.019).TP negative was an important index to predict the recovery of CD4/CD8 ratio(HR=2.46,95CI(1.312-2.972),P<0.001).3.Recurrence of syphilis significantly increased the risk of treatment failure(HR=4.45,95CI(1.875-32.414),P=0.005).Conclusion:1.HIV-infected people have a high rate of TP infection and recurrence.The main population of HIV-infected people with TP infection were young and middle-aged men who have sex with men or bisexuals.2.HIV combined with TP infection significantly affects the immune recovery after antiviral treatment.3.HIV combined with TP infection significantly increases the risk of failure and death after antiviral treatment. |
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