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. 2000 Dec;76(6):462–469. doi: 10.1136/sti.76.6.462

Predictors of syphilis seroreactivity and prevalence of HIV among street recruited injection drug users in Los Angeles County, 1994–6

J Lopez-Zetina 1, W Ford 1, M Weber 1, S Barna 1, T Woerhle 1, P Kerndt 1, E Monterroso 1
PMCID: PMC1744247  PMID: 11221130

Abstract

Objectives: To describe HIV prevalence and the association between syphilis incidence and sexual and drug injection risk behaviours in a cohort of street recruited injecting drug users (IDUs) in Los Angeles County, between 1994 and 1996.

Methods: During the study period, 513 street recruited African-American and Latino IDUs were screened for syphilis and antibodies to HIV. Subjects were administered a risk behaviour survey at baseline and followed up at 6 month intervals for 18 months with repeated interviews and serological screening. Rate ratios were used to examine associations between syphilis incidence and demographic characteristics and risk behaviours. A proportional hazard model was used to identify predictors of syphilis incidence independent of demographic characteristics.

Results: 74% of the sample were male, 70% African-American, 30% Latino; and the median age was 43 years. Overall baseline serological prevalence of HIV was 2.5% and of syphilis 5.7%. None of the participants were co-infected for HIV and syphilis at baseline or at any of the 6 month follow ups. Among 390 eligible IDUs retained for analysis of incidence data, the overall syphilis incidence was 26.0 per 1000 person years. Higher syphilis incidence was found for women compared with men (RR=2.70; 95% CI 1.60, 4.55), and for those 44 years of age or younger compared with those 45 years of age and older (RR=2.26; 95% CI 1.25, 4.08). African-Americans were more likely to be syphilis incident cases when compared with Latinos, although the difference did not reach statistical significance (RR=1.27; 95% CI 0.72, 2.23). In bivariate analysis, risk behaviours significantly associated with higher syphilis incidence included injection of cocaine, "speedball" and heroin, "crack" smoking, recency of first injection event, backloading of syringes, injecting with others, exchanging drugs or money for sex, multiple sex partners, and non-heterosexual sexual preference. Variables that significantly predicted syphilis infection at follow up in the multivariate analysis included multiple sex partners (RR=7.8; 95% CI 2.4, 25.0), exchanging money for sex (RR=3.0; 95% CI 0.9, 9.6), and recent initiation to injection drug use (RR=4.6; 95% CI 1.1, 18.8).

Conclusion: Syphilis transmission among IDUs in Los Angeles County remains a serious public health concern, particularly among IDUs who engage in trading of sex for money or drugs. Although low, the prevalence of HIV observed in this study constitutes a serious concern because of the potential for expanded HIV transmission in this susceptible population of IDUs with high syphilis incidence. Enhanced case finding screening efforts and prevention of transmission of sexually transmitted infections should specifically target hard to reach IDUs and their sexual partners.

Key Words: syphilis incidence; injection drug users; HIV prevalence

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Selected References

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  1. Ansell D. A., Hu T. C., Straus M., Cohen M., Sherer R. HIV and syphilis seroprevalence among clients with sexually transmitted diseases attending a walk-in clinic at Cook County Hospital. Sex Transm Dis. 1994 Mar-Apr;21(2):93–96. doi: 10.1097/00007435-199403000-00007. [DOI] [PubMed] [Google Scholar]
  2. Battjes R. J., Pickens R. W., Amsel Z. Introduction of HIV infection among intravenous drug abusers in low prevalence areas. J Acquir Immune Defic Syndr. 1989;2(6):533–539. [PubMed] [Google Scholar]
  3. Booth R. E., Watters J. K., Chitwood D. D. HIV risk-related sex behaviors among injection drug users, crack smokers, and injection drug users who smoke crack. Am J Public Health. 1993 Aug;83(8):1144–1148. doi: 10.2105/ajph.83.8.1144. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chaisson R. E., Bacchetti P., Osmond D., Brodie B., Sande M. A., Moss A. R. Cocaine use and HIV infection in intravenous drug users in San Francisco. JAMA. 1989 Jan 27;261(4):561–565. [PubMed] [Google Scholar]
  5. Chaisson R. E., Moss A. R., Onishi R., Osmond D., Carlson J. R. Human immunodeficiency virus infection in heterosexual intravenous drug users in San Francisco. Am J Public Health. 1987 Feb;77(2):169–172. doi: 10.2105/ajph.77.2.169. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Flores J. L. Syphilis. A tale of twisted treponemes. West J Med. 1995 Dec;163(6):552–559. [PMC free article] [PubMed] [Google Scholar]
  7. Friedman S. R., Des Jarlais D. C. HIV among drug injectors: the epidemic and the response. AIDS Care. 1991;3(3):239–250. doi: 10.1080/09540129108253069. [DOI] [PubMed] [Google Scholar]
  8. Friedman S. R., Jose B., Deren S., Des Jarlais D. C., Neaigus A. Risk factors for human immunodeficiency virus seroconversion among out-of-treatment drug injectors in high and low seroprevalence cities. The National AIDS Research Consortium. Am J Epidemiol. 1995 Oct 15;142(8):864–874. doi: 10.1093/oxfordjournals.aje.a117726. [DOI] [PubMed] [Google Scholar]
  9. Gourevitch M. N., Hartel D., Schoenbaum E. E., Selwyn P. A., Davenny K., Friedland G. H., Klein R. S. A prospective study of syphilis and HIV infection among injection drug users receiving methadone in the Bronx, NY. Am J Public Health. 1996 Aug;86(8):1112–1115. doi: 10.2105/ajph.86.8_pt_1.1112. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Herrera G. A., Lackritz E. M., Janssen R. S., Raimondi V. P., Dodd R. Y., Aberle-Grasse J., Petersen L. R. Serologic test for syphilis as a surrogate marker for human immunodeficiency virus infection among United States blood donors. Transfusion. 1997 Aug;37(8):836–840. doi: 10.1046/j.1537-2995.1997.37897424407.x. [DOI] [PubMed] [Google Scholar]
  11. Holmberg S. D. The estimated prevalence and incidence of HIV in 96 large US metropolitan areas. Am J Public Health. 1996 May;86(5):642–654. doi: 10.2105/ajph.86.5.642. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hser Y. I. Population estimates of intravenous drug users and HIV infection in Los Angeles County. Int J Addict. 1993 Jun;28(8):695–709. doi: 10.3109/10826089309062167. [DOI] [PubMed] [Google Scholar]
  13. Kerndt P. R., Weber M., Ford W., Prevots D. R., Lehman J. S. HIV incidence among injection drug users enrolled in a Los Angeles methadone program. JAMA. 1995 Jun 21;273(23):1831–1832. doi: 10.1001/jama.1995.03520470039016. [DOI] [PubMed] [Google Scholar]
  14. Kilmarx P. H., St Louis M. E. The evolving epidemiology of syphilis. Am J Public Health. 1995 Aug;85(8 Pt 1):1053–1054. doi: 10.2105/ajph.85.8_pt_1.1053. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Levine O. S., Vlahov D., Koehler J., Cohn S., Spronk A. M., Nelson K. E. Seroepidemiology of hepatitis B virus in a population of injecting drug users. Association with drug injection patterns. Am J Epidemiol. 1995 Aug 1;142(3):331–341. doi: 10.1093/oxfordjournals.aje.a117639. [DOI] [PubMed] [Google Scholar]
  16. Lewis D. K., Watters J. K. Sexual risk behavior among heterosexual intravenous drug users: ethnic and gender variations. AIDS. 1991 Jan;5(1):77–83. doi: 10.1097/00002030-199101000-00011. [DOI] [PubMed] [Google Scholar]
  17. Metzger D. S., Woody G. E., McLellan A. T., O'Brien C. P., Druley P., Navaline H., DePhilippis D., Stolley P., Abrutyn E. Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of-treatment: an 18-month prospective follow-up. J Acquir Immune Defic Syndr. 1993 Sep;6(9):1049–1056. [PubMed] [Google Scholar]
  18. Muga R., Roca J., Tor J., Pigem C., Rodriguez R., Egea J. M., Vlahov D., Muñoz A. Syphilis in injecting drug users: clues for high-risk sexual behaviour in female IDUs. Int J STD AIDS. 1997 Apr;8(4):225–228. doi: 10.1258/0956462971919967. [DOI] [PubMed] [Google Scholar]
  19. Nandwani R., Evans D. T. Are you sure it's syphilis? A review of false positive serology. Int J STD AIDS. 1995 Jul-Aug;6(4):241–248. doi: 10.1177/095646249500600404. [DOI] [PubMed] [Google Scholar]
  20. Nelson K. E., Vlahov D., Cohn S., Odunmbaku M., Lindsay A., Antohony J. C., Hook E. W., 3rd Sexually transmitted diseases in a population of intravenous drug users: association with seropositivity to the human immunodeficiency virus (HIV). J Infect Dis. 1991 Sep;164(3):457–463. doi: 10.1093/infdis/164.3.457. [DOI] [PubMed] [Google Scholar]
  21. Onorato I. M., Klaskala W., Morgan W. M., Withum D. Prevalence, incidence, and risks for HIV-1 infection in female sex workers in Miami, Florida. J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Aug 1;9(4):395–400. [PubMed] [Google Scholar]
  22. Otten M. W., Jr, Zaidi A. A., Peterman T. A., Rolfs R. T., Witte J. J. High rate of HIV seroconversion among patients attending urban sexually transmitted disease clinics. AIDS. 1994 Apr;8(4):549–553. doi: 10.1097/00002030-199404000-00020. [DOI] [PubMed] [Google Scholar]
  23. Quinn T. C., Glasser D., Cannon R. O., Matuszak D. L., Dunning R. W., Kline R. L., Campbell C. H., Israel E., Fauci A. S., Hook E. W., 3rd Human immunodeficiency virus infection among patients attending clinics for sexually transmitted diseases. N Engl J Med. 1988 Jan 28;318(4):197–203. doi: 10.1056/NEJM198801283180401. [DOI] [PubMed] [Google Scholar]
  24. Schöfer H., Imhof M., Thoma-Greber E., Brockmeyer N. H., Hartmann M., Gerken G., Pees H. W., Rasokat H., Hartmann H., Sadri I. Active syphilis in HIV infection: a multicentre retrospective survey. The German AIDS Study Group (GASG). Genitourin Med. 1996 Jun;72(3):176–181. doi: 10.1136/sti.72.3.176. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Siegal H. A., Carlson R. G., Falck R., Li L., Forney M. A., Rapp R. C., Baumgartner K., Myers W., Nelson M. HIV infection and risk behaviors among intravenous drug users in low seroprevalence areas in the Midwest. Am J Public Health. 1991 Dec;81(12):1642–1644. doi: 10.2105/ajph.81.12.1642. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Siegel D., Larsen S. A., Golden E., Morse S., Fullilove M. T., Washington A. E. Prevalence, incidence, and correlates of syphilis seroreactivity in multiethnic San Francisco neighborhoods. Ann Epidemiol. 1994 Nov;4(6):460–465. doi: 10.1016/1047-2797(94)90006-x. [DOI] [PubMed] [Google Scholar]
  27. St Louis M. E. Strategies for syphilis prevention in the 1990s. Sex Transm Dis. 1996 Jan-Feb;23(1):58–67. doi: 10.1097/00007435-199601000-00012. [DOI] [PubMed] [Google Scholar]
  28. Thomas D. L., Cannon R. O., Shapiro C. N., Hook E. W., 3rd, Alter M. J., Quinn T. C. Hepatitis C, hepatitis B, and human immunodeficiency virus infections among non-intravenous drug-using patients attending clinics for sexually transmitted diseases. J Infect Dis. 1994 May;169(5):990–995. doi: 10.1093/infdis/169.5.990. [DOI] [PubMed] [Google Scholar]
  29. Thomas D. L., Quinn T. C. Serologic testing for sexually transmitted diseases. Infect Dis Clin North Am. 1993 Dec;7(4):793–824. [PubMed] [Google Scholar]
  30. Watters J. K., Estilo M. J., Kral A. H., Lorvick J. J. HIV infection among female injection-drug users recruited in community settings. Sex Transm Dis. 1994 Nov-Dec;21(6):321–328. doi: 10.1097/00007435-199411000-00005. [DOI] [PubMed] [Google Scholar]
  31. Williams M. L., Elwood W. N., Weatherby N. L., Bowen A. M., Zhao Z., Saunders L. A., Montoya I. D. An assessment of the risks of syphilis and HIV infection among a sample of not-in-treatment drug users in Houston, Texas. AIDS Care. 1996 Dec;8(6):671–682. doi: 10.1080/09540129650125380. [DOI] [PubMed] [Google Scholar]
  32. Wilson T. E., Minkoff H., DeHovitz J., Feldman J., Landesman S. The relationship of cocaine use and human immunodeficiency virus serostatus to incident sexually transmitted diseases among women. Sex Transm Dis. 1998 Feb;25(2):70–75. doi: 10.1097/00007435-199802000-00003. [DOI] [PubMed] [Google Scholar]
  33. Zeldis J. B., Jain S., Kuramoto I. K., Richards C., Sazama K., Samuels S., Holland P. V., Flynn N. Seroepidemiology of viral infections among intravenous drug users in northern California. West J Med. 1992 Jan;156(1):30–35. [PMC free article] [PubMed] [Google Scholar]

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