Bibliographic citations
Vargas, S., (2024). Evaluación de la respuesta inmune a sífilis, y factores asociados a su incidencia en poblaciones clave usuarios de clínicas de ITS del Perú: factores asociados a sífilis en CERITS [Universidad Peruana Cayetano Heredia]. https://hdl.handle.net/20.500.12866/16350
Vargas, S., Evaluación de la respuesta inmune a sífilis, y factores asociados a su incidencia en poblaciones clave usuarios de clínicas de ITS del Perú: factores asociados a sífilis en CERITS []. PE: Universidad Peruana Cayetano Heredia; 2024. https://hdl.handle.net/20.500.12866/16350
@phdthesis{renati/1281884,
title = "Evaluación de la respuesta inmune a sífilis, y factores asociados a su incidencia en poblaciones clave usuarios de clínicas de ITS del Perú: factores asociados a sífilis en CERITS",
author = "Vargas Rivera, Silver Keith",
publisher = "Universidad Peruana Cayetano Heredia",
year = "2024"
}
Syphilis remains a major public health problem today. The sequelae of congenital syphilis can be fatal, yet it is an epidemic that primarily affects certain populations, including men who have sex with men (MSM), and transgender women (TW), who should be screened frequently; however, current diagnostic tests are based on antibody detection, which cannot be easily detected at certain stages of infection, or do not allow full identification of cases in tested subjects. Given the need for new technologies for the detection and monitoring of syphilis that facilitate an early and correct diagnosis, mainly in populations that concentrate the largest number of cases, we proposed a study in order to generate evidence for the use of cytokines as a biomarker in patients with syphilis, we measured two cytokine networks, that showed good performance in identifying cases of active syphilis previously, at different stages of the disease. Likewise, given the importance of studying the dynamics of syphilis in the framework of new HIV prevention strategies, for key populations in Peru such as MSM and MT, we evaluated the association of adherence to pre-exposure prophylaxis (PrEP) with the incidence of syphilis to generate evidence that could be used in the implementation of new public health programs Our research questions were: 1) what is the relationship between syphilis stage and the concentration of two cytokine networks (Eotaxin-Rantes-Leptin and IL1ra-Trail-CD40L) at the time of diagnosis and treatment, and at seven days post-treatment in serum of syphilis patients attending STI clinics? 2) What is the relationship between adherence to PrEP and syphilis incidence in men who have sex with men and transgender women enrolled in the ImPrEP implementation study? Two projects were conducted: a first pre-post study, nested in a cohort study of patients with syphilis, which included a visit at 7 days post- treatment, to perform an additional blood collection and evaluate the association between cytokine levels and syphilis stage. In the second study, based on data collected in the longitudinal study of the implementation of pre-exposure prophylaxis (PrEP) for HIV in MSM and TW users of Ministry of Health (MINSA) STI clinics in different cities of Peru, we evaluated the association between adherence to PrEP (MPR, Medication Posession Ratio) and the incidence of syphilis. In addition, the incidence of syphilis and associated factors were assessed before and after the declaration of quarantine due to the COVID-19 health emergency. In the first project, 31 syphilis cases were included. The median of RANTES (10073.3 [IQR: 7465]) vs 14697.3 [5604.8]) and IL1RA (28.5 [11.3] vs 23 [6.8]) were different at 7 days post-treatment compared to the median at baseline (p-value<0.05). However, the levels of the cytokines studied were not associated with syphilis stage; furthermore, we found that there was an association between HIV status and the variation of Eotaxin, IL1RA and SCD40L levels at 7 days compared to baseline (p-value<0.05). In the second study we included data from 2292 subjects who were enrolled in the ImPrEP and followed May 2018 and June 2021; we found that syphilis incidence were higher among PrEP adherent participants (MPR≥0.6) (Incidence Rate Ratio, (IRR): 1.48 [95% CI: 1.09 - 2.00]; among those reporting condomless anal sex (1.53 [1.11 - 2.11]) and among transgender woman (1.66 [1.09 - 2.53]); In the pre-post confinement analysis (before and after 16/03/2020), in the pre-confinement period syphilis incidence was higher among PrEP adherent participants (1.50 [1.01-2.23] and among those reporting condomless anal sex (2.35 [1.43-3.86]. Syphilis diagnosis at enrollment was the only factor associated with syphilis incidence in the post-confinement period (2.70 [1.67-4.36]). The incidence of syphilis in the entire cohort was 9.07 (95%CI: 7.91-10.40) per 100 person-years (p.a.); syphilis incidence in PrEP-adherent individuals was 9.97 (8.42 - 11.71) and the incidence of syphilis among transgender women was 14.72 (10.47 - 20.12) per 100 p.a. We found no association between syphilis stage and cytokine values; two cytokines (RANTES and IL1RA) presented variations in their concentrations at 7 days compared to baseline, and we found that HIV status is associated with variation in the levels of three cytokines (Eotaxin, IL1RA and SCD40L). This result suggests that there is a potential use of cytokines as immunological markers of disease progression or for diagnosis of active infection, however, measurements with longer intervals between measurements are required to identify changes in the immune system during the syphilis response. In addition, in PrEP users, the incidence of syphilis is higher among PrEP adherent users, among those reporting condomless sex and among transgender woman; specific strategies are required to accompany this implementation for the target populations and to reduce the impact of STIs, especially among the most vulnerable groups.
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