HIV and syphilis co-infection increasing among men who have sex with men in China: a systematic review and meta-analysis.

Eric P F Chow,David P Wilson,Lei Zhang,Claire Thorne

doi:10.1371/journal.pone.0022768

Abstract

BackgroundThis 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 FindingsChinese 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/SignificanceThere 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.

Highlights

Over the last decade in many international settings there have been resurgences in syphilis epidemics among men who have sex with men (MSM), which have been strongly associated with the increases in HIV incidence [1,2,3,4,5]
Keywords used in the database search included (‘‘HIV’’ OR ‘‘AIDS’’) OR (‘‘STD’’ OR ‘‘Sexually transmitted diseases’’ OR ‘‘Syphilis’’) OR (‘‘co-infection’’) AND (‘‘homosexual’’ OR ‘‘gay’’ OR ‘‘bisexual’’ OR ‘‘men who have sex with men’’ OR ‘‘MSM’’) AND ‘‘China’’
Study selection Studies were eligible for inclusion in this systematic review if they met the following criteria: (1) study published in Chinese or English language; (2) study reported both HIV and syphilis prevalence estimates among MSM in China; (3) HIV and syphilis infection must be diagnosed from laboratory serologic testing; (4) study design such as study site, time period and sample size must be reported

Summary

Introduction

Over the last decade in many international settings there have been resurgences in syphilis epidemics among men who have sex with men (MSM), which have been strongly associated with the increases in HIV incidence [1,2,3,4,5]. Syphilis infection has returned to become one of the top five most reported notifiable diseases in China [7,8,9,10]. The estimated number of people living with HIV in China has increased markedly from 400,000 in 2007 to 740,000 in 2009 [14]. 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

Objectives

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Results

Conclusion