Background In the recent decade resurgence of syphilis was noted in a global scale, especially in high-risk communities like men who have sex with men (MSM) and commercial sex workers (CSW). Syphilis co-infection is important in people living with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) because of their similar transmission routes, mutual interactions at pathophysiology level, relation to socioeconomic factors and public health implications. Methods Retrospective analysis of syphilis co-infections among the HIV/AIDS patients who have been under the care of the AIDS Clinical Service, Queen Elizabeth Hospital of Hong Kong which has served as a tertiary referral center since the beginning of the AIDS epidemic. Details of syphilis co-infection including their clinical stages on diagnosis, evidence of central nervous system (CNS) invasion and recurrence were analyzed. Results In the 1,567 subjects studied 223 (14.2%) had HIV/syphilis co-infection. There are significantly more MSM in the HIV/syphilis co-infected group (P < 0.001). Among the coinfected, 111 (49.8%) had undiagnosed and untreated syphilis at the time of HIV/AIDS diagnosis. Sixty two subjects (27.8%) acquired syphilis as totally new infections after followed up for HIV/AIDS, with a median time of 284.6 weeks (range 3.7-862.3 weeks). Twenty subjects (9.0%) showed evidence of neurosyphilis on cerebrospinal fluid study. Thirty two (14.3%) had recurrent syphilis infections and more than 80% of them occurred in MSM. The total follow up duration was 8616.58 person-years. By Poisson regression, the adjusted total syphilis incidence was 7.07 cases per 100 person-years. MSM had the highest syphilis incidence of 20.25 cases per 100 person-years. In addition syphilis incidence in MSM recruited after the year 2000 was higher than those MSM recruited before. When Comparing subjects with HIV infection diagnosed before 2000 with those having HIV infection diagnosed after 2000, latter have higher cumulative incidence of first syphilis events (P < 0.001). Using Cox regression analysis, MSM (hazard ratio 3.26, 95% CI 1.93 – 5.51, P < 0.0005), bisexual contact (hazard ratio 2.95, 95% CI 1.49 – 5.82, P < 0.005) and infection with HIV-1 subtype B (hazard ratio 1.65, 95% CI 1.08 – 2.53, P = 0.02) were associated with development of first event of syphilis infection during follow up. Conclusions The result of this study corresponded to the global trend of HIV/syphilis syndemic. New and recurrent syphilis infections continued to appear after combination antiretroviral therapy (cART) initiation. MSM, bisexual subjects and infection by HIV-1 subtype B were risk factors for syphilis events. MSM contained the highest syphilis burden. Urgent attention and measures are needed to target syphilis and HIV infection in the Hong Kong MSM population. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Architecture / Master / Master of Architecture

published_or_final_version / abstract / Community Medicine / Doctoral / Doctor of Philosophy

吳木欣. / "2008年7月". / "2008 nian 7 yue". / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 169-174). / Abstracts in Chinese and English. / Wu Muxin. / 目錄 / 引言 --- p.9 / Chapter 第一章 --- 文獻回顧 / Chapter 1 --- 何謂 MSM? --- p.11 / Chapter 2 --- 回顧亞洲男男性接觸者感染愛滋病之情況 --- p.11 / Chapter 3 --- 愛滋病感染率急升之原因 --- p.14 / Chapter 3.1 --- 香港同性戀者情況 --- p.17 / Chapter 4 --- 各地政府和NGOs之回應 --- p.19 / Chapter ■ --- 歧視與愛滋病的關連 --- p.20 / Chapter 4.1 --- 美國經驗´ؤ´ؤ活動取向之多元 --- p.21 / Chapter 4.2 --- 亞洲經驗一政府的不支持，非政府組織的無力 --- p.23 / Chapter 5 --- 回顧政府和香港非政府組織(NGOs)的角色 --- p.24 / Chapter 5.1 --- 香港政府採取的措施 --- p.24 / Chapter 5.1.1 --- ACA的建議政策角色 --- p.26 / Chapter 5.1.2 --- ATF的撥款機制角色 --- p.28 / Chapter 5.1.3 --- 非政府組織的工作 --- p.35 / Chapter 6 --- 是次研究的分析框架和概念 --- p.38 / Chapter 7 --- 研究重要之處 --- p.45 / Chapter 第二章 --- 研究方法 --- p.47 / Chapter 第三章 --- 誰是決策者 --- p.52 / Chapter 第四章 --- 主流組織的失敗一一反思一筆過撥款的弊端 --- p.73 / Chapter 第五章 --- 愛滋病非政府組織的無力 --- p.94 / Chapter 第六章 --- 草根組織的掙扎求存 --- p.103 / Chapter 第七章 --- 政府的割裂 --- p.115 / Chapter 第八章 --- 非政府組織的工作---愛滋病只是愛滋病嗎？ --- p.130 / Chapter 第九章 --- 總結 --- p.158 / 參考文獻 --- p.169 / 附件一 --- p.175 / 附件二 --- p.176