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Use of the serologic testing algorithm for recent HIV seroconversion
(STARHS) to identify recently acquired HIV infections in men with early syphilis
in Los Angeles County.
Journal of Acquired Immune Deficiency Syndrome 2005; 38(5):505-508.
Taylor MM, Hawkins K, Gonzalez A, Buchacz K, Aynalem G, Smith LV, Klausner
J, Holmberg S, Kerndt PR.
Abstract
BACKGROUND: Syphilis outbreaks among men who have sex with men (MSM) in the
United States, many of whom are HIV infected, have prompted increased concern
for HIV transmission. METHODS: To identify whether men are acquiring HIV
concomitantly or within the critical period of syphilis infection, banked
Treponema pallidum particle agglutination-positive serum specimens from men
with early syphilis infection were screened for HIV-1 antibody. Samples that
were positive for HIV antibody were then tested with a less sensitive (LS)
HIV-1 antibody enzyme immunoassay (serologic testing algorithm for recent
HIV seroconversion [STARHS]) to identify HIV infections that occurred on
average within the previous 6 months. RESULTS: Of the 212 specimens banked
from men with early syphilis, 74 (35%) were HIV-positive. Of these, 15 tested
non-reactive by the LS assay. Twelve of these 15 were considered to be recent
infections by the LS assay and testing history. Eleven (92%) of the recent
infections were among MSM. One man had primary syphilis, 6 (50%) had secondary
syphilis, and 5 (42%) had early latent syphilis. Eight men (67%) reported
sex with anonymous partners, and 3 (25%) reported consistent condom use.
The estimated HIV incidence was 17% per year (95% confidence interval [CI]:
12%-22%) among all men with early syphilis, and it was 26% per year (95%
CI: 91%-33%) among MSM. CONCLUSIONS: Syphilis epidemics in MSM may be contributing
to HIV incidence in this population. The STARHS can be applied as a surveillance
tool to assess HIV incidence in various at-risk populations, but further
studies are necessary for validation.