The prevalence of syphilis from the early HIV period is correlated with peak HIV prevalence at a country level

BACKGROUND: Could we have predicted national peak HIV based on syphilis prevalence in the 1990s? Earlier studies have shown positive correlations between various sexually transmitted infections at different population levels. In this article, we test the hypothesis that there was a residual variation in the national prevalence rates of syphilis and that these rates could predict subsequent peak HIV prevalence rates.

METHODS: This analysis uses linear regression to evaluate the country-level relationship between antenatal syphilis prevalence (1990-1999) and peak HIV prevalence. Antenatal syphilis data were taken from an Institute for Health Metrics and Evaluation database on the prevalence of syphilis in low-risk populations. Peak HIV prevalence was calculated based on data taken from the Global Health Observatory Data Repository of the World Health Organization.

RESULTS: A moderately strong association is found for the 76 countries with data available (R = 0.53, P < 0.001). The association was weakened but remained significantly positive when we adjusted for the type of syphilis testing used.

CONCLUSIONS: Syphilis prevalence in the 1990s predicted approximately 53% of the variation in peak HIV prevalence. Populations with generalized HIV epidemics had a higher prevalence of syphilis in the pre-HIV period. This finding provides additional rationale to carefully monitor sexual behavior, sexual networks, and sexually transmitted infection incidence in these populations.