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Volume 47, Number 6, December 2015

Associated factors with syphilis among human immunodeficiency virus-infected men who have sex with men in Taiwan in the era of combination antiretroviral therapy 

Yi-Hsin Chang, Wen-Chun Liu, Sui-Yuan Chang, Bing-Ru Wu, Pei-Ying Wu, Mao-Song Tsai, Chien-Ching Hung, Chih-Yin Lew-Ting

Received: April 3, 2013    Revised: September 4, 2013    Accepted: November 4, 2013   


Corresponding author:

Corresponding author. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of
Medicine, 7, Chung-Shan South Road, Taipei 100, Taiwan.
E-mail address: (C.-C. Hung) 


Background and purpose: 

Little is known about the factors associated with syphilis among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) with access to combination antiretroviral therapy (cART) in Taiwan, where MSM has re-emerged as the leading risk group for HIV transmission. 



From March to October 2011, MSM who regularly attended HIV clinics at a university hospital were invited to participate in the study. A structured questionnaire interview was conducted to collect information on sociodemographic characteristics, immunologic and virologic status, sexual partners and patterns of sexual behavior, and use of recreational drugs. 



During the study period, 310 HIV-infected MSM with a mean age of 35.5 years were enrolled, of which 82.3% (n = 255) were sexually active and 37.4% (n = 116) used recreational drugs in the past 6 months. Syphilis was self-reported in 46.5% (n = 144) of the participants after HIV infection was diagnosed and 37.5% (112/299) had serologic evidence of syphilis within 1 year before enrollment. Multivariate logistic regression analysis limited to those who were receiving cART showed that higher CD4 counts [adjusted odds ratio (AOR): 1.17; 95% confidence interval (CI): 1.02–1.34], lower educational achievement (AOR: 1.95; 95% CI: 1.05–3.63), serosorting (AOR: 3.32; 95% CI: 1.04–10.63), and use of recreational drugs (AOR: 2.55; 95% CI: 1.26–5.13) were associated with syphilis. 



Improved immune status, lower educational achievement, serosorting, and use of recreational drugs were associated with syphilis among HIV-infected MSM who were receiving cART. These findings suggest that strengthening client-specific counseling is needed to reduce risks for syphilis among HIV-infected MSM in Taiwan. 


Key words:

Recreational drug, Risky sexual behavior, Serosorting, Sexually transmitted infection