Diagnostic performance of two rapid tests for syphilis screening in people living with HIV in Cali, Colombia.

INTRODUCTION: There is insufficient evidence supporting the use of rapid diagnostic tests (RDTs) for syphilis in people living with HIV (PLWH). We evaluated the diagnostic performance of two commercially available RDTs (Bioline and Determine) in PLWH in Cali, Colombia. METHODS: A cross-sectional field validation study on consecutive adults with confirmed HIV diagnosis attending three outpatient clinics. Both RDTs were performed on capillary blood (CB), obtained by finger prick, and sera, by venipuncture. A combination of treponemal enzyme linked immunosorbent assay (ELISA) and Treponema pallidum haemagglutination assay (TPHA) on serum samples was the reference standard. Rapid plasma reagin (RPR) and clinical criteria were added to define active syphilis. Sensitivity and specificity, predictive values and likelihood ratios (LR) of RDTs were estimated with their corresponding 95% confidence interval (95% CI). Stratified analyses by sample type, patient characteristics, non-treponemal titers, operator and re-training were performed. RESULTS: 244 PLWH were enrolled, of whom 112 (46%) had positive treponemal reference tests and 26/234 (11.1%) had active syphilis. The sensitivities of Bioline on CB and sera were similar (96.4% vs 94.6%, p = 0.6). In contrast, Determine had a lower sensitivity on CB than sera (87.5% vs 99.1%, p<0.001). Sensitivities were lower in PLWH not receiving ART (Bioline 87.1% and Determine 64.5%, p<0.001) and for one of the operators (Bioline 85% and Determine 60%, p<0.001). Specificities of the RDTs were > 95% in most analyses. Predictive values were 90% or higher. For active syphilis, the RDTs showed a similar performance pattern but with decreased specificities. CONCLUSION: The studied RDTs have an excellent performance in PLWH to screen for syphilis and potentially for active syphilis, yet Determine performs better on sera than CB. Patient characteristics and potential difficulties operators may face in acquiring enough blood volume from finger pricks should be considered for the implementation and the interpretation of RDTs.

Comorbidities among adults living with hiv from two healthcare centers in Colombia / Comorbilidad entre adultos viviendo con VIH en dos centros de atención en Colombia

Objective: To determine the prevalence of comorbidities among adults living with HIV from two healthcare centers in Colombia, and to identify factors associated with comorbidity-free years. Methods: Observational, retrospective medical chart review study. Summary statistics for demographic and clinical characteristics were developed and relationship between comorbidity-free years were analyzed through Kaplan-Meier analysis and Cox regression. Results: 669 clinical charts were included, 71.7% were male and 16.1% were 50 years or older, 69.96% had at least one comorbidity. The most frequent comorbidities were dislipidemia(15.06%), hypertension(5.67%), risk factors were tobacco use(15.33%), alcohol intake(24.36%) and drugs abuse (14.66%). Discussion: These findings are consistent with previous reports showing the underlying processes of patients, producing multiple comorbidities. Conclusions: Significant proportion of patients have comorbidities that may increase risk of other complications or reduced comorbidity-free years. Poly-pharmacy among HIV+ adults need to be addressed to ensure adherence and minimize drug-drug interactions.

Objetivo: Determinar la prevalencia de comorbilidades entre adultos viviendo con VIH en dos centros de atención en Colombia e identificar los factores asociados con años libres de comorbilidad . Metodos: Revisión observacional retrospectiva de historias clínicas. Resumen de estadísticas de características demográficas y clínicas y análisis de correlación entre características clínicas a través de pruebas de Kaplan-Meier y regresión de Cox. Resultados: Se analizaron 669 historias clínicas, 71.7% fueron hombres y 16.1% tuvieron 50 años o más, 69.96% tuvieron al menos una comorbilidad. Las comorbilidades más frecuentes fueron dislipidemia(15.06%), hipertensión (5.67%), los factores de riesgo fueron el uso de tabaco (15.33%), ingesta de alcohol (24.36%) y abuso de drogas (14.66%). Discusión: Estos hallazgos son consistentes con reportes previos que evidencian los procesos subyacentes que llevan a múltiples comorbilidades. Conclusiones: Una proporción significativa de pacientes tiene comorbilidades que pueden aumentar el riesgo de otras condiciones o los años libres de comorbilidad. La polifarmacia en pacientes HIV+ debe hacerse de manera que se asegure la adherencia y se minimicen las interacciones entre medicamentos.