Contribution of Syphilis to Adverse Pregnancy Outcomes in People Living With and Without HIV in South Brazil: 2008 to 2018.

IF 2.4 4区医学 Q3 INFECTIOUS DISEASES

Sexually transmitted diseases Pub Date : 2024-10-01 Epub Date: 2024-05-02 DOI:10.1097/OLQ.0000000000001993

Lanbo Z Yang, Kavya G Sundar, Mary Catherine Cambou, Emma J Swayze, Eddy R Segura, Marineide Gonçalves de Melo, Breno Riegel Santos, Ivana Rosângela Dos Santos Varella, Karin Nielsen-Saines

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引用次数: 0

Abstract

Background: Syphilis coinfection among pregnant people living with HIV (PLH) may worsen pregnancy outcomes. We evaluated the impact of syphilis coinfection on pregnancies in south Brazil.

Methods: Data were extracted from hospital records between January 1, 2008, and December 31, 2018. Preterm birth (PTB), low birth weight (LBW <2500 g), and a composite adverse infant outcome (AIO: HIV vertical transmission, loss to follow-up before HIV diagnosis, stillbirth, congenital syphilis) were evaluated among pregnancies without HIV and syphilis (PWOH + S), PLH monoinfection, syphilis monoinfection (PLS), and PLH with syphilis (PLH + S).

Results: Among 48,685 deliveries where patients were tested for HIV and syphilis, 1353 (2.8%) occurred in PLH; of these, 181 (13.4%) were HIV/syphilis coinfected (PLH + S). Among PLH, 2.4% of infants acquired HIV and 13.1% were lost to follow-up before HIV diagnosis. Among all PLS, 70.5% of infants acquired congenital syphilis. Across the cohort, 1.2% stillbirths/neonatal deaths occurred. Thirty-seven percent of PLH + S did not initiate antiretroviral therapy versus 15.4% of PLH monoinfection ( P < 0.001). Less than half (37.6%) of PLH + S had VDRL titers ≥1:16 compared with 21.7% of PLS only ( P < 0.001). Among PLH, syphilis coinfection and unknown/high VDRL titers (≥1:16) increased AIO risk more (adjusted relative risk [aRR], 3.96; 95% confidence interval [CI], 3.33-4.70) compared with low VDRL titers (≤1:8; aRR, 3.51; 95% CI, 2.90-4.25). Unsuppressed viremia (≥50 copies/mL) was associated with risk of PTB (aRR, 1.43; 95% CI, 1.07-1.92) and AIO (aRR, 1.38; 95% CI, 1.11-1.70) but not LBW. Lack of prenatal care was significant in predicting PTB and LBW in all PLH and PLS monoinfection.

Conclusions: Syphilis coinfection worsens AIOs in all women and compounds negative effects of HIV infection during pregnancy. Effective syphilis treatment and HIV viral load suppression are paramount for optimal obstetric care.

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2008-2018年巴西南部梅毒对艾滋病毒感染者和非艾滋病毒感染者不良妊娠结局的影响。

背景：妊娠期艾滋病病毒感染者（PLH）合并梅毒感染可能会恶化妊娠结局。我们评估了梅毒合并感染对巴西南部妊娠的影响：从2008年1月1日至2018年12月31日的医院记录中提取数据。对未感染艾滋病毒和梅毒的孕妇（PWOH+S）、单一感染 PLH 的孕妇、单一感染梅毒的孕妇（PLS）和感染梅毒的 PLH 孕妇（PLH + S）的早产（PTB）、低出生体重（LBW < 2500 g）和婴儿综合不良结局[AIO：HIV 垂直传播、HIV 诊断前失去随访（LTFU）、死产、先天性梅毒]进行了评估：在对 48685 例分娩进行艾滋病毒和梅毒检测的患者中，有 1353 例（2.8%）为 PLH；其中 181 例（13.4%）为艾滋病毒/梅毒合并感染者（PLH + S）。在PLH中，2.4%的婴儿感染了艾滋病毒，13.1%的婴儿感染了LTFU。在所有PLS中，70.5%的婴儿感染了先天性梅毒。在整个群体中，1.2%的婴儿死产/新生儿死亡。37.0%的PLH + S未开始抗逆转录病毒疗法，而15.4%的PLH为单一感染（P < 0.001）。37.6%的PLH + S患者的VDRL滴度大于1:16，而只有21.7%的PLS患者的VDRL滴度大于1:16（P < 0.001）。与低VDRL滴度（< 1:8）（aRR:3.51，95%CI:2.90-4.25）相比，在PLH中，梅毒合并感染和未知/高VDRL滴度（> 1:16）会增加AIO风险（aRR:3.96，95%CI:3.33-4.70）。未抑制的病毒血症（> 50 copies/mL）与 PTB（aRR:1.43，95%CI:1.07-1.92）和 AIO（aRR:1.38，95%CI:1.11-1.70）的风险有关，但与低出生体重儿无关。在所有PLH和PLS单一感染者中，缺乏产前护理对预测PTB和LBW具有重要意义：结论：梅毒合并感染会加重所有产妇的不良婴儿预后，并加重孕期感染艾滋病病毒的负面影响。有效的梅毒治疗和HIV VL抑制对最佳产科护理至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Sexually transmitted diseases 医学-传染病学

CiteScore

4.00

自引率

16.10%

发文量

289

审稿时长

3-8 weeks

期刊介绍： Sexually Transmitted Diseases, the official journal of the American Sexually Transmitted Diseases Association, publishes peer-reviewed, original articles on clinical, laboratory, immunologic, epidemiologic, behavioral, public health, and historical topics pertaining to sexually transmitted diseases and related fields. Reports from the CDC and NIH provide up-to-the-minute information. A highly respected editorial board is composed of prominent scientists who are leaders in this rapidly changing field. Included in each issue are studies and developments from around the world.