Syphilis in HIV-infected Mothers and Infants Results from the NICHD/HPTN 040 Study

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.NICHDUCLA Center for AIDS ResearchUCLA AIDS InstituteBoehringer Ingelheim Pharmaceuticals Inc. (BIPI)GlaxoSmithKline on behalf of ViiV HealthcareDavid Geffen UCLA Sch Med, Los Angeles, CA USAEunice Kennedy Shriver Natl Inst Child Hlth & Hum, Bethesda, MD USAWESTAT Corp, Rockville, MD 20850 USAHosp Fed Serv Estado, Rio de Janeiro, BrazilHosp Geral Nova Iguacu, Nova Iguacu, BrazilFundacao Oswaldo Cruz Fiocruz, Inst Oswaldo Cruz, Lab AIDS & Immnol Mol, Rio de Janeiro, BrazilUniv Witwatersrand, Perinatal HIV Res Unit, Chris Hani Baragwanath Hosp, Johannesburg, South AfricaUniv Stellenbosch, Tygerberg Hosp, Cape Town, South AfricaHosp Conceicao, Porto Alegre, RS, BrazilHosp Femina, Oporto, PortugalIrmandade Santa Casa Misericordia Porto Alegre, Porto Alegre, RS, BrazilUniv Fed Minas Gerais, Belo Horizonte, MG, BrazilUniv São Paulo, BR-14049 Ribeirao Preto, SP, BrazilFdn Maternal & Infant Hlth FUNDASAMIN, Buenos Aires, DF, ArgentinaUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilFundacao Oswaldo Cruz Fiocruz, Lab Pesquisa Clin DST & AIDS, Inst Pesquisa Clin Evandro Chagas, Rio de Janeiro, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilNICHD: HHSN267200800001CNICHD: U01 AI047986UCLA AIDS Institute: 5P30 AI28697Web of Scienc