HIV-1-Syphilis Co-infection Associated with High Viral Load in Female Sex Workers in the Democratic Republic of the Congo

Abstract

Background: Sexually transmitted infection (STI) and HIV co-infection are common in countries where resources are limited constituting a leading public health issue. The negative impact of HIV transmission and acquisition are known. The aim of this study was to determine whether HIV-1-syphilis co-infection is associated with high HIV-1 viral load (VL) in female sex workers (FSWs) in the Democratic Republic of the Congo (DRC).
 Methods: Sera from 411 FSWs tested HIV+ in a national, DRC HIV/STI Integrated Biological and Behavioral Surveillance Survey (IBBSS) conducted between December 2012 and January 2013. HIV and syphilis testing were performed according to validated DRC national testing algorithms used by the national HIV-AIDS and STI program (PNLS). VL was measured according to Abbot m2000sp and m2000rt protocols. HIV-1-syphilis co-infection proportion was determined and multivariate analyses were used to identify factors associated with higher VL in HIV-1-syphilis co-infected FSWs.
 Results: Of 411 HIV-infected FSWs, 19.2% (95% CI: 15.4 – 23.0) were co-infected with syphilis. The mean HIV-1 VL in HIV-1-positive FSWs co-infected with syphilis [2.9 log10 HIV RNA/mL (95% CI: 2.49 – 3.29)] was higher compared with those not co-infected with syphilis [2.2 log10 HIV RNA/mL (95% CI: 1.97 – 2.46)]. Multivariate analysis showed that syphilis co-infection was associated with high HIV-1 VL (aOR [95% CI] = 1.90 [1.03, 3.52]) but HIV-1 VL was not influenced by age, education level, duration in sex profession, abnormal fluid, and sore to sex.
 Conclusion and Implications for Translation: HIV-1 – Syphilis co-infection was associated with higher HIV-1 VL. Preventing FSWs from getting STIs and screening HIV infected individuals for STIs and providing them with appropriate treatment could impact the transmission of HIV from FSWs to their clients.
 Keywords: • HIV-1 • Syphilis • Co-infection • Viral load • Female sex workers • DRC
 
 Copyright © 2020 Musema et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Prevalence of HIV and Syphilis and Related Risk Behaviors Among Female Sex Workers in the Democratic Republic of the Congo

“…In Central Africa, the burden of syphilis has been well documented in selected groups such as blood donors and pregnant women (Niama et al, 2017;Taylor et al, 2014). In 2011 and 2014, the prevalence of syphilis among pregnant women attending sentinel antenatal clinics was 4.2% and 2.8% (Musema et al, 2020;Taylor et al, 2014), respectively. Our results showed that the prevalence of syphilis among FSW in Kinshasa was as high as 11.5%.…”

Predictive Factors of HIV-1 Drug Resistance and Its Distribution among Female Sex Workers in the Democratic Republic of the Congo (DRC)

“…High HIV-1 VLs have been attributed to multiple infections or superinfections that are often found in FSWs [ 30 ]. They may also be due to HIV-1–syphilis coinfection [ 24 ] or with other STIs, such as gonorrhea, chlamydia, herpes, etc. [ 31 ]; these were not considered in this study.…”

“…Indeed, HIV coinfection with other infections (including sexually transmitted infections (STIs), tuberculosis, and hepatitis) aggravates HIV infection, increases its VL and facilitates its transmission [ 22 , 23 ]. Musema et al reported a strong association between coinfection of HIV-1 and high HIV-1 VL in FSWs from the DRC [ 24 ].…”