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      HIV and Syphilis Co-Infection Increasing among Men Who Have Sex with Men in China: A Systematic Review and Meta-Analysis

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          Abstract

          Background

          This study aims to estimate the magnitude and changing trends of HIV, syphilis and HIV-syphilis co-infections among men who have sex with men (MSM) in China during 2003–2008 through a systematic review of published literature.

          Methodology/Principal Findings

          Chinese and English literatures were searched for studies reporting HIV and syphilis prevalence among MSM from 2003 to 2008. The prevalence estimates were summarized and analysed by meta-analyses. Meta-regression was used to identify the potential factors that are associated with high heterogeneities in meta-analysis. Seventy-one eligible articles were selected in this review (17 in English and 54 in Chinese). Nationally, HIV prevalence among MSM increased from 1.3% during 2003–2004 to 2.4% during 2005–2006 and to 4.7% during 2007–2008. Syphilis prevalence increased from 6.8% during 2003–2004 to 10.4% during 2005–2006 and to 13.5% during 2007–2008. HIV-syphilis co-infection increased from 1.4% during 2005–2006 to 2.7% during 2007–2008. Study locations and study period are the two major contributors of heterogeneities of both HIV and syphilis prevalence among Chinese MSM.

          Conclusions/Significance

          There have been significant increases in HIV and syphilis prevalence among MSM in China. Scale-up of HIV and syphilis screening and implementation of effective public health intervention programs should target MSM to prevent further spread of HIV and syphilis infection.

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          Most cited references98

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          Syphilis in China: results of a national surveillance programme

          Summary Background After a massive syphilis epidemic in the first half of the 20th century, China was able to eliminate this infection for 20 years (1960–80). However, substantial changes in Chinese society have been followed by a resurgent epidemic of sexually transmitted diseases. Sporadic reports have provided clues to the magnitude of the spread of syphilis, but a national surveillance effort is needed to provide data for planning and intervention. Methods We collected and assessed case report data from China's national sexually transmitted disease surveillance system and sentinel site network. Findings In 1993, the reported total rate of cases of syphilis in China was 0·2 cases per 100 000, whereas primary and secondary syphilis alone represented 5·7 cases per 100 000 persons in 2005. The rate of congenital syphilis increased greatly with an average yearly rise of 71·9%, from 0·01 cases per 100 000 livebirths in 1991 to 19·68 cases per 100 000 livebirths in 2005. Interpretation The results suggest that a range of unique biological and social forces are driving the spread of syphilis in China. A national campaign for detection and treatment of syphilis, and a credible prevention strategy, are urgently needed.
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            Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART.

            The objective of this study is to estimate per-contact probability of HIV transmission in homosexual men due to unprotected anal intercourse (UAI) in the era of HAART. Data were collected from a longitudinal cohort study of community-based HIV-negative homosexual men in Sydney, Australia. A total of 1427 participants were recruited from June 2001 to December 2004. They were followed up with 6-monthly detailed behavioral interviews and annual testing for HIV till June 2007. Data were used in a bootstrapping method, coupled with a statistical analysis that optimized a likelihood function for estimating the per-exposure risks of HIV transmission due to various forms of UAI. During the study, 53 HIV seroconversion cases were identified. The estimated per-contact probability of HIV transmission for receptive UAI was 1.43% [95% confidence interval (CI) 0.48-2.85] if ejaculation occurred inside the rectum, and it was 0.65% (95% CI 0.15-1.53) if withdrawal prior to ejaculation was involved. The estimated transmission rate for insertive UAI in participants who were circumcised was 0.11% (95% CI 0.02-0.24), and it was 0.62% (95% CI 0.07-1.68) in uncircumcised men. Thus, receptive UAI with ejaculation was found to be approximately twice as risky as receptive UAI with withdrawal or insertive UAI for uncircumcised men and over 10 times as risky as insertive UAI for circumcised men. Despite the fact that a high proportion of HIV-infected men are on antiretroviral treatment and have undetectable viral load, the per-contact probability of HIV transmission due to UAI is similar to estimates reported from developed country settings in the pre-HAART era.
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              A systematic review of the epidemiologic interactions between classic sexually transmitted diseases and HIV: how much really is known?

              Many studies have explored the role of "classic" sexually transmitted diseases (STDs) in determining the pattern of HIV epidemics. However, the many different STDs may contribute in different ways, at different magnitudes. To review available studies on the bidirectional interactions of HIV and STDs to explore the extent of current knowledge on the different influences of the varied STDs in heterosexual HIV epidemics. Longitudinal studies on susceptibility and controlled studies on infectiousness and duration of disease identified on electronic databases through reference lists and citation indices up to the end of 1999 were systematically reviewed, including meta-analyses assessing the influence of STDs on susceptibility to HIV. Studies have a clear publication bias with a significant result that hinders robust interpretation. However, genital ulcerative disease appears to have a greater impact than nonulcerative disease, and men are more affected than women by the effects of STDs on susceptibility to HIV. There is evidence that STDs increase the infectiousness of HIV from men to women, whereas the evidence is more equivocal for the infectiousness of women. Few studies identify the impact of different STDs, and there is a marked lack of studies investigating the impact of HIV infection on the transmission of other STDs. A large body of work has measured the association between STDs and HIV. However, publication bias and gaps in the focus of studies mean that a detailed, quantitative understanding of the interaction requires much more attention.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2011
                15 August 2011
                : 6
                : 8
                : e22768
                Affiliations
                [1]The Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, University of New South Wales, Sydney, Australia
                UCL Institute of Child Health, University College London, United Kingdom
                Author notes

                Conceived and designed the experiments: EPFC LZ. Performed the experiments: EPFC. Analyzed the data: EPFC. Wrote the paper: EPFC LZ DPW. Provided strategic advice throughout the study: DPW LZ.

                Article
                PONE-D-11-07784
                10.1371/journal.pone.0022768
                3156129
                21857952
                b2d9a91a-fc5c-4b53-a0e3-422e7e77c8af
                Chow et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                : 1 May 2011
                : 29 June 2011
                Page count
                Pages: 1
                Categories
                Research Article
                Biology
                Population Biology
                Epidemiology
                Infectious Disease Epidemiology
                Spatial Epidemiology
                Medicine
                Epidemiology
                Infectious Disease Epidemiology
                Spatial Epidemiology
                Infectious Diseases
                Sexually Transmitted Diseases
                Syphilis
                Viral Diseases
                HIV

                Uncategorized
                Uncategorized

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