engleski

Increasing incidence of syphilis among people living with HIV in Croatia during the COVID-19 years 2020 and 2021

Background: Croatia has a low-level HIV epidemic, men who have sex with men (MSM) are mainly affected [1]. HIV care is centralised, all people living with HIV (PLWHIV) are treated at the University Hospital for Infectious Diseases (UHID) in Zagreb [2]. We assessed temporal trends and associated risk factors for newly diagnosed syphilis in PLWHIV in the period 2018 to 2021. Materials and methods: Incident syphilis infection occurring in PLWHIV were reviewed from the electronic database at UHID. New syphilis cases were defined based on a combination of established laboratory parameters as well as clinical diagnoses. All adults (≥18 years) followed at UHID for at least 1 year with at least one contact between 1 January 2018 and 31 December 2021 were included in this study (N = 1315). The observation period ended with the last date of contact or 31 December 2021. We calculated the annual incidence density of syphilis diagnoses and performed Poisson GEE regression analysis for factors related to new syphilis diagnoses and testing. Results: Of 1315 PLWHIV, 1184 (90.2%) were men, median age was 42.0 (34.9 to 51.1) years (Table 1). Two hundred and eleven PLWHIV had a total of 271 new syphilis diagnoses during 4740.1 years of follow-up. Of 271 events, 128 (47.2%) were first syphilis diagnoses, and 162 (59.8%) had symptomatic syphilis (secondary, n = 97). The overall syphilis incidence was 5.7 (95% CI 5.0 to 6.6) per 100 person-years (PY), it increased from 3.2 (95% CI 2.3 to 4.5) to 8.2 (95% CI 6.8 to 10.0) per 100 PY during 2018 to 2021 (Figure 1). On adjusted analysis (adjusted for the number of tests and other variables) younger age, calendar year, MSM risk was associated with syphilis, the association with living in Zagreb was less pronounced (Figure 1). The rate of syphilis testing doubled between 2018 (50.4, 95% CI 56.5 to 64.6 per 100 PY) and 2021 (123.0, 95% CI 118.1 to 128.1 per 100 PY). Factors related to the frequency of syphilis testing were: age, calendar year, MSM risk, and living in Zagreb (Figure 1). Conclusions: During the COVID-19 epidemic years, the incidence rate of syphilis was more than 2 times higher than in previous years reflecting ongoing sexual risk in predominantly younger MSM and highlighting the need for enhanced prevention interventions. References: 1. European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2021 – 2020 data. Stockholm: ECDC ; 2021. 2. Bogdanić N, Bendig L, Lukas D, Zekan Š, Begovac J. Timeliness of antiretroviral therapy initiation in the era before universal treatment. Sci Rep. 2021:11:10508.

Syphilis ; HIV ; Croatia ; COVID-19

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