(P423) Syphilis prevalence among people living with HIV in Sub-Saharan Africa: A systematic review and meta-analysis

Background: Syphilis is a curable sexually transmitted infection which, if left untreated, is associated with significant morbidity and mortality. In people living with HIV (PLWH), untreated syphilis infection carries greater risks of severe disease, including neurologic complications, but data on syphilis prevalence among PLWH outside of the US and Europe is limited. We estimated syphilis prevalence among PLWH in the general population in Sub-Saharan Africa (SSA) and compared prevalence among people living with and without HIV.

Methods: We searched PubMed, Embase, Web of Science, regional databases, and country reports for studies published between 1^st January 2011 and 28^th March 2022 reporting syphilis prevalence among PLWH in SSA, following PRISMA guidelines (PROSPERO#: CRD42020167328). We excluded studies in high risk groups, e.g. men who have sex with men and female sex workers. We extracted data on syphilis prevalence among PLWH and, when included in the same study, people without HIV. We estimated pooled prevalence among PLWH and compared prevalence to people without HIV using random effects modelling. We also examined the influences of region, sex, and test type in subgroup analyses.



Results: We identified 927 unique records, of which 53 studies were included in the meta-analysis. Pooled prevalence of syphilis among PLWH was 7.3% (95% CI: 6.3%-8.5%). Prevalence differed by region: 3.1% (95% CI: 2.3%-4.0%) in Southern, 5.5% (95% CI: 2.3%-9.3%) in West/Central, and 10.5% (95% CI: 8.0%-13.1%) in Eastern Africa. Syphilis prevalence was higher among PLWH than people without HIV (RR: 3.54, 95% CI: 2.77-4.53). There was no significant difference in syphilis prevalence between males and females living with HIV (RR: 0.94; 95% CI: 0.76-1.16). The majority of studies reported prevalence using a combined treponemal (i.e. treponemal antibody) and non-treponemal (e.g., rapid plasma reagin) testing algorithm rather than treponemal- or non-treponemal-only testing; when limiting studies to the combined approach, pooled prevalence among PLWH did not change substantially (6.6%; 95% CI: 5.0%-8.4%).



Conclusion: Syphilis is highly prevalent among PLWH and is more common among PLWH than people without HIV in SSA. Integration of syphilis screening, monitoring and management into HIV care may reduce HIV-syphilis co-infection among PLWH in SSA.