Ramirez HIV syphilis IDWeek.ppt · •Whether RPR testing was performed and results of RPR....
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Sandy Ramirez MD, Susan Szpunar PhD, Leonard B. Johnson MD Department of Internal Medicine St. John Hospital and Medical Center, Detroit, Michigan References 1. Nicola M. Zetola, MD, Joseph Engelman, MD, Trevor P. Jensen, and Jeffrey D. Klausner, MD, MPH. Syphilis in the United States: An Update for Clinicians with an Emphasis on HIV Coinfection. Mayo Clinic Proc. 2007; 82(9): 1091-1102. 2. Witold Jarzebowski, MD, MSc, Eric Caumes, MD, Nicolas Dupin, MD, David Farhi, MD, MPH, Anne-Sophie Lascaux, MD, Christophe Piketty, MD, PhD, Pierre de Truchis, MD, Marie-Anne Bouldouyere, MD, Ouda Derradji, MD, Jerome Pacanowski, MD, Dominique Costagliola, PhD, Sophie Grabar, MD, PhD. Effect of Early Syphilis infection on plasma viral load and CD4 cell count in Human Immunodeficiency Virus-Infected Men. Arch Intern Med/Vol 172 (No. 16) Sep 10, 2012, 1237-1242. 3. Nicola M. Zetola and Jeffrey D. Klausner. Syphilis and HIV infection: An Update. Clinical Infectious Diseases 2007;44:1222-8(1 May). 4. Judith A. Aberg, Jonathan E. Kaplan, Howard Libman, Patricia Emmanuel, Jean R. Anderson, Valerie E. Stone, James M. Oleske, Judith S. Currier, and Joel E. Gallant. Primary Care Guidelines for the management of persons infected with HIV: 2009 update by the HIV medicine association of the infectious disease society of America. Clinical Infectious Disease 2009; 49:651- 81. 5. CDC MMWR/Vol. 61/No 5, November 9, 2012. Introduction •The CDC recommends syphilis serology to be performed annually for established HIV patients, especially MSM. •The HIV Medicine Association (HIVMA) and Infectious Diseases Society of America (IDSA) have recommended that all HIV patients at their initial visit have syphilis screening with annual testing for those who have high-risk sexual behavior on follow up visits. •From logistic regression controlling for the two variables that were significant on univariate analysis (age, sexual history obtained), only obtaining a sexual history remained significant with an odds ratio of 4.16 (confidence interval: 2.1-8.2). Results •Among 220 HIV patients seen during this time period, 173 met inclusion criteria. •Age 46.6 + 11.6 (Mean + SD). 122 (70.5%) were male. •115 (66.5%) Black, 44 (25.4%) White. •86 (49.7%) were men who have sex with men (MSM), 82 (47.4%) were heterosexual. •102 (59%) patients had RPR test performed during the time period. •93 (91.2%) were screening tests. •9 (8.8%) were tested for either symptoms or syphilis exposure. •90 (88.2%) of the tests were negative. •Among the 12 positive tests, the median titer was 2 (range 2-512). •9/12 (75%) of the positive tests were done for screening. Summary & Conclusion: •There is an opportunity to increase syphilis screening among HIV+ patients. •Most tests were performed were for screening and most were negative. •In multivariate analysis, only documentation of a sexual history was predictive of testing for syphilis. •Taking a sexual history is predictive of performing syphilis screening •The study is limited as it is a single center study and some patients may have had a sexual history obtained but not documented. Leonard Johnson, MD 19251 Mack Avenue Suite 340 Grosse Pointe Woods, MI. 48236 Email: [email protected] Don’t Ask, Don’t Test? Rates of Syphilis Screening Among Urban HIV Patients Purpose 1) To determine the frequency of annual syphilis screening in HIV patients that are seen by the Infectious Diseases practice at our institution. 2) To evaluate if there are any differences by age, gender, ethnicity, sexual orientation, sexual history, and RPR results between those with annual screening and those without screening. Methods • To assess compliance with IDSA and CDC guidelines on syphilis screening in patients with HIV, we evaluated adult HIV patients with >2 visits in an urban Infectious Disease practice from 01-01-11 to 12-31-11. •Data collected: •Age, gender, ethnicity. •Sexual orientation - Documentation of sexual history. •Whether RPR testing was performed and results of RPR. •Patients with and without RPR testing during the period were compared using chi- squared analysis, Student’s t-test and logistic regression using SPSS v.22.0. •A p value of <0.05 was considered to indicate statistical significance. Table. Comparison of patients based on RPR testing.
Transcript of Ramirez HIV syphilis IDWeek.ppt · •Whether RPR testing was performed and results of RPR....
Sandy Ramirez MD, Susan Szpunar PhD, Leonard B. Johnson MDDepartment of Internal Medicine
St. John Hospital and Medical Center, Detroit, Michigan
References1. Nicola M. Zetola, MD, Joseph Engelman, MD, Trevor P. Jensen, and Jeffrey D. Klausner, MD,
MPH. Syphilis in the United States: An Update for Clinicians with an Emphasis on HIV Coinfection. Mayo Clinic Proc. 2007; 82(9): 1091-1102.
2. Witold Jarzebowski, MD, MSc, Eric Caumes, MD, Nicolas Dupin, MD, David Farhi, MD, MPH, Anne-Sophie Lascaux, MD, Christophe Piketty, MD, PhD, Pierre de Truchis, MD, Marie-Anne Bouldouyere, MD, Ouda Derradji, MD, Jerome Pacanowski, MD, Dominique Costagliola, PhD, Sophie Grabar, MD, PhD. Effect of Early Syphilis infection on plasma viral load and CD4 cell count in Human Immunodeficiency Virus-Infected Men. Arch Intern Med/Vol 172 (No. 16) Sep 10, 2012, 1237-1242.
3. Nicola M. Zetola and Jeffrey D. Klausner. Syphilis and HIV infection: An Update. ClinicalInfectious Diseases 2007;44:1222-8(1 May).
4. Judith A. Aberg, Jonathan E. Kaplan, Howard Libman, Patricia Emmanuel, Jean R. Anderson, Valerie E. Stone, James M. Oleske, Judith S. Currier, and Joel E. Gallant. Primary Care Guidelines for the management of persons infected with HIV: 2009 update by the HIV medicine association of the infectious disease society of America. Clinical Infectious Disease 2009; 49:651-81.
5. CDC MMWR/Vol. 61/No 5, November 9, 2012.
Introduction •The CDC recommends syphilis serology to be performed annually for established HIV patients, especially MSM.
•The HIV Medicine Association (HIVMA) and Infectious Diseases Society of America (IDSA) have recommended that all HIV patients at their initial visit have syphilis screening with annual testing for those who have high-risk sexual behavior on follow up visits.
•From logistic regression controlling for the two variables that were significant on univariate analysis (age, sexual history obtained), only obtaining a sexual history remained significant with an odds ratio of 4.16 (confidence interval: 2.1-8.2).
Results•Among 220 HIV patients seen during this time period, 173 met inclusion criteria.
•Age 46.6 + 11.6 (Mean + SD). 122 (70.5%) were male.
•115 (66.5%) Black, 44 (25.4%) White.
•86 (49.7%) were men who have sex with men (MSM), 82 (47.4%) were heterosexual.
•102 (59%) patients had RPR test performed during the time period.
•93 (91.2%) were screening tests.
•9 (8.8%) were tested for either symptoms or syphilis exposure.
•90 (88.2%) of the tests were negative.
•Among the 12 positive tests, the median titer was 2 (range 2-512).
•9/12 (75%) of the positive tests were done for screening.
Summary & Conclusion:•There is an opportunity to increase syphilis screening among HIV+ patients.
•Most tests were performed were for screening and most were negative.•In multivariate analysis, only documentation of a sexual history was predictive of testing for syphilis.•Taking a sexual history is predictive of performing syphilis screening•The study is limited as it is a single center study and some patients may have had a sexual history obtained but not documented.
Leonard Johnson, MD
19251 Mack Avenue
Suite 340
Grosse Pointe Woods, MI. 48236
Email: [email protected]
Don’t Ask, Don’t Test? Rates of Syphilis Screening Among Urban HIV Patients
Purpose
1) To determine the frequency of annual syphilis screening in HIV patients that are seen by the Infectious Diseases practice at our institution.
2) To evaluate if there are any differences by age, gender, ethnicity, sexual orientation, sexual history, and RPR results between those with annual screening and those without screening.
Methods • To assess compliance with IDSA and CDC guidelines on syphilis screening in patients with HIV, we evaluated adult HIV patients with >2 visits in an urban Infectious Disease practice from 01-01-11 to 12-31-11.
•Data collected:
•Age, gender, ethnicity.
•Sexual orientation - Documentation of sexual history.
•Whether RPR testing was performed and results of RPR.
•Patients with and without RPR testing during the period were compared using chi-squared analysis, Student’s t-test and logistic regression using SPSS v.22.0.
•A p value of <0.05 was considered to indicate statistical significance.
Table. Comparison of patients based on RPR testing.
