Syphilis in HIV-infected Mothers and Infants: Results from the NICHD/HPTN 040 Study. Issue 3 (March 2015)

• Record Type: Journal Article
• Authors: Yeganeh, Nava; Watts, Heather D.; Camarca, Margaret; Soares, Gabriel; Joao, Esau; Pilotto, Jose Henrique; Gray, Glenda; Theron, Gerhard; Santos, Breno; Fonseca, Rosana; Kreitchmann, Regis; Pinto, Jorge; Mussi-Pinhata, Marisa; Ceriotto, Mariana; Maria Machado, Daisy; Veloso, Valdilea G.; Grinzstejn, Beatriz; Morgado, Mariza G.; Bryson, Yvonne; Mofenson, Lynne M.; Nielsen-Saines, Karin
• Is Part Of: Pediatric infectious disease journal. Volume 34:Issue 3(2015)
• Publication Date: 2015-03
• Subjects: HIV mother to child transmission -- congenital syphilis -- prenatal care; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000000578
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: Untreated syphilis during pregnancy is associated with spontaneous abortion, stillbirth, prematurity and infant mortality. Syphilis may facilitate HIV transmission, which is especially concerning in low- and middle-income countries where both diseases are common. Methods: We performed an analysis of data available from NICHD/HPTN 040 (P1043), a study focused on the prevention of intrapartum HIV transmission to 1684 infants born to 1664 untreated HIV-infected women. This analysis evaluates risk factors and outcomes associated with a syphilis diagnosis in this cohort of HIV-infected women and their infants. Results: Approximately, 10% of women (n = 171) enrolled had serological evidence of syphilis without adequate treatment documented and 1.4% infants (n = 24) were dually HIV and syphilis infected. Multivariate logistic analysis showed that compared with HIV-infected women, co-infected women were significantly more likely to self-identify as non-white (adjusted odds ratio [AOR] 2.5, 95% CI: 1.5–4.2), to consume alcohol during pregnancy (AOR 1.5, 95% CI: 1.1–2.1) and to transmit HIV to their infants (AOR 2.1, 95% CI: 1.3–3.4), with 88% of HIV infections being acquired in utero. As compared with HIV-infected or HIV-exposed infants, co-infected infants were significantly more likely to be born to mothers with venereal disease research laboratory titers ≥1:16 (AOR 3, 95% CI: 1.1–8.2) and higher viral loads (AOR 1.5, 95% CI: 1.1–1.9). Of 6 newborns with symptomatic syphilis, 2 expired shortly after birth, and 2 were HIV-infected. Conclusion: Syphilis continues to be a common co-infection in HIV-infected women and can facilitate in utero transmission of HIV to infants. Most infants are asymptomatic at birth, but those with symptoms have high mortality rates. Abstract : Supplemental Digital Content is available in the text.