Prevalence and Risk Factors for Syphilis and Hepatitis B Co-Infection Among Newly-Diagnosed HIV-Infected Adults in Durban, South Africa

Abstract

Objective To estimate the prevalence of and risk factors for co-infection with syphilis or hepatitis B (HBV) among newly-diagnosed HIV-infected adults in an urban township of KwaZulu-Natal. Methods We conducted a cross-sectional study of newly-diagnosed HIV infected adults at an outpatient HIV clinic in Durban, South Africa. Baseline demographics, socio-economic indicators, behavioral factors, substance use history, mental health, and historical clinical indicators were collected prior to HIV testing. Individuals were tested for syphilis using the rapid plasma reagin and were tested for HBV using a blood antibody test. We estimated prevalence and used stepwise logistic regression to elucidate risk factors for syphilis or HBV co-infection with HIV. Results Among 1,900 HIV-infected adults, prevalence of syphilis and HIV co-infection was 4.0% (95% CI: 3.0%-5.3%), and prevalence of HBV co-infection was 8.8% (95% CI: 7.3%-10.6%). Syphilis co-infection was significantly associated with being <30 years old (aOR = 1.93, 95% CI: 1.03-3.60). HBV co-infection was independently associated with being male (aOR = 1.97, 95% CI: 1.29-3.01) and having a CD4 count ≤200 cells/µL (aOR = 2.29, 95% CI: 1.09-4.83) after adjusting for sex, age, and CD4 count. Conclusions A more universal screening program could identify many HIV-infected individuals with either syphilis or HBV co-infection at the time of HIV testing in resource-limited settings of sub-Saharan Africa.