Syphilis Testing as a Proxy Marker for a Subgroup of Men Who Have Sex With Men With a Central Role in HIV-1 Transmission in Guangzhou, China

Frontiers in Medicine

article

Liping Huang¹  Hao Wu²  Huanchang Yan¹  Yuanhao Liang¹  Qingmei Li²  Jingwei Shui¹  Zhigang Han³  Shixing Tang¹ 

[1] Department of Epidemiology, School of Public Health, Southern Medical University;Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention;Institute of Public Health, Guangzhou Medical University;Wenzhou Institute, University of Chinese Academy of Sciences

关键词: syphilis;    HIV-1;    transmission network;    screening;    men who have sex with men;   

DOI  :  10.3389/fmed.2021.662689

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Objectives: The objectives of this study were to distinguish the role of men who have sex with men (MSM) with or without syphilis testing in HIV-1 transmission and to provide molecular evidence of syphilis testing as a proxy marker for identifying the subgroup of MSM. Methods: HIV-1 transmission clusters were constructed by HIV-TRACE and Cluster Picker using HIV-1 pol sequences from 729 newly diagnosed HIV-infected MSM from 2008 to 2012 in Guangzhou, China. The role of MSM in HIV-1 transmission networks was determined by a node influence measurement and centrality analysis. The association between syphilis testing and factors related to HIV-1 transmission and antiretroviral treatment (ART) were analyzed by the Cox regression model. Results: Among HIV-infected MSM, 56.7% did not test for syphilis at the time of HIV-1 diagnosis. MSM without syphilis testing was a specific subgroup of MSM with a larger closeness centrality and clustering coefficient than the recipients of syphilis testing ( P < 0.001), indicating their central position in the HIV-1 transmission networks. The median degree and radiality within HIV-1 transmission networks as well as the median K-shell scores were also greater for MSM without syphilis testing ( P < 0.001), suggesting their relatively greater contribution in transmitting HIV-1 than the receipts of syphilis testing. MSM with syphilis testing usually did not disclose their occupation or were more likely to be unemployed or to take non-skilled jobs, to have a history of sexually transmitted infections (STIs), and to be AIDS patients when diagnosed with HIV-1 infection ( P < 0.05). Multivariable Cox regression analysis indicated that syphilis testing per se did not promote the engagement of ART ( P = 0.233) or affect the speed of CD4 + T cell count recovery after treatment ( P = 0.256). Conclusions: Our study identifies syphilis testing as a proxy marker of a specific subgroup of HIV-infected MSM who refuse syphilis testing during HIV-1 diagnosis with an important role in HIV-1 transmission. Specific prevention and intervention targeting MSM without syphilis testing during HIV-1 care are urgently needed.

【 授权许可】

CC BY