Syphilis testing, incidence, and reinfection among gay and bisexual men in Australia over a decade spanning HIV PrEP implementation: an analysis of surveillance data from 2012 to 2022

IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES The Lancet Regional Health: Western Pacific Pub Date : 2024-08-24 DOI:10.1016/j.lanwpc.2024.101175
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Abstract

Background

Gay and bisexual men (GBM) remain overrepresented among syphilis diagnoses in Australia and globally. The extent to which changes in sexual networks associated with HIV pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) may have influenced syphilis transmission among GBM at the population-level is poorly understood. We describe trends in syphilis testing and incidence among GBM in Australia over eleven years spanning widespread uptake of HIV PrEP and TasP.

Methods

We analysed linked clinical data from GBM aged 16 years or older across a sentinel surveillance network in Australia from January 1, 2012, to December 31, 2022. Individuals with at least two clinic visits and with at least two syphilis tests during the observations period were included in testing and incidence analyses, respectively. Annual rates of testing and infectious syphilis incidence from 2012 to 2022 were disaggregated by HIV status and PrEP use (record of PrEP prescription; retrospectively categorised as ever or never-PrEP user). Cox regression explored associations between demographics, PrEP use and history of bacterial sexually transmissible infections (STIs) and infectious syphilis diagnosis.

Findings

Among 129,278 GBM (mean age, 34.6 years [SD, 12.2]) included in testing rate analyses, 7.4% were living with HIV at entry and 31.1% were prescribed PrEP at least once during the study period. Overall syphilis testing rate was 114.0/100 person-years (py) and highest among GBM with HIV (168.4/100 py). Syphilis testing increased from 72.8/100 py to 151.8/100 py; driven largely by increases among ever-PrEP users. Among 94,710 GBM included in incidence analyses, there were 14,710 syphilis infections diagnosed over 451,560 person-years (incidence rate = 3.3/100 py). Syphilis incidence was highest among GBM with HIV (6.5/100 py), followed by ever-PrEP users (3.5/100 py) and never-PrEP users (1.4/100 py). From 2012 to 2022, syphilis incidence increased among ever-PrEP users from 1.3/100 py to 5.1/100 py, and fluctuated between 5.4/100 py and 6.6/100 py among GBM with HIV. In multivariable Cox regression, previous syphilis diagnosis (adjusted hazard ratio [aHR] = 1.98, 95% CI = 1.83–2.14), living with HIV (aHR = 1.83, 95% CI = 1.12–1.25) and recent (past 12 m) prescription of PrEP (aHR = 1.78, 95% CI = 1.61–1.97) were associated with syphilis diagnosis.

Interpretation

Syphilis trends between GBM with HIV and GBM with evidence of PrEP use have converged over the past decade in Australia. Our findings recommend targeting emergent syphilis control strategies (e.g. doxycycline post-exposure prophylaxis) to GBM with prior syphilis diagnoses, using HIV PrEP or who are living with HIV.

Funding

Australian Department of Health and Aged Care, National Health and Medical Research Council.

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澳大利亚男同性恋者和双性恋者中梅毒检测、发病率和再感染情况:对 2012 年至 2022 年监测数据的分析
背景在澳大利亚和全球梅毒诊断中,男同性恋者和双性恋者(GBM)所占比例仍然过高。人们对与艾滋病暴露前预防(PrEP)和治疗即预防(TasP)相关的性网络变化在多大程度上影响了梅毒在GBM人群中的传播还知之甚少。我们描述了澳大利亚在广泛采用HIV PrEP和TasP的11年间GBM梅毒检测和发病率的趋势。在观察期间至少接受过两次门诊就诊和至少两次梅毒检测的个体分别纳入检测和发病率分析。2012年至2022年期间的年检测率和感染性梅毒发病率按艾滋病病毒感染状况和PrEP使用情况(PrEP处方记录;回顾性分为曾经或从未使用过PrEP)分列。Cox回归探讨了人口统计学、PrEP使用情况、细菌性性传播感染(STI)病史与传染性梅毒诊断之间的关联。研究结果在纳入检测率分析的129278名GBM(平均年龄34.6岁[标码:12.2])中,7.4%在入组时感染了HIV,31.1%在研究期间至少开具过一次PrEP处方。总体梅毒检测率为 114.0/100 人-年(py),感染 HIV 的 GBM 检测率最高(168.4/100 人-年)。梅毒检测率从72.8/100人年上升到151.8/100人年,这主要是由于曾经使用过PrEP的人群中梅毒检测率的上升。在纳入发病率分析的 94,710 名 GBM 中,451,560 人年中诊断出 14,710 例梅毒感染(发病率 = 3.3/100 py)。梅毒发病率最高的是感染了艾滋病毒的GBM(6.5/100人),其次是曾经使用过PrEP者(3.5/100人)和从未使用过PrEP者(1.4/100人)。从2012年到2022年,在曾经使用过PrEP的人群中,梅毒发病率从1.3/100 py上升到5.1/100 py,而在感染艾滋病毒的GBM人群中,梅毒发病率则在5.4/100 py和6.6/100 py之间波动。在多变量 Cox 回归中,既往梅毒诊断(调整后危险比 [aHR] = 1.98,95% CI = 1.83-2.14)、HIV 感染者(aHR = 1.83,95% CI = 1.12-1.25)和近期(过去 12 m)PrEP 处方(aHR = 1.78,95% CI = 1.61-1.97)与梅毒诊断相关。我们的研究结果表明,梅毒控制策略(如强力霉素暴露后预防)应针对曾诊断出梅毒、使用HIV PrEP或感染HIV的GBM。
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来源期刊
The Lancet Regional Health: Western Pacific
The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health
CiteScore
8.80
自引率
2.80%
发文量
305
审稿时长
11 weeks
期刊介绍: The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.
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