{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:00:08Z","timestamp":1753891208819,"version":"3.41.2"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T00:00:00Z","timestamp":1625616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010843","name":"Guangzhou Science, Technology and Innovation Commission","doi-asserted-by":"publisher","award":["201604020011","201704020219","201707010184","201803040002"],"award-info":[{"award-number":["201604020011","201704020219","201707010184","201803040002"]}],"id":[{"id":"10.13039\/501100010843","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2018ZX10732401-003"],"award-info":[{"award-number":["2018ZX10732401-003"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Objectives:<\/jats:bold> The objectives of this study were to distinguish the role of men who have sex with men (MSM) with or without syphilis testing in HIV-1 transmission and to provide molecular evidence of syphilis testing as a proxy marker for identifying the subgroup of MSM.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> HIV-1 transmission clusters were constructed by HIV-TRACE and Cluster Picker using HIV-1 pol sequences from 729 newly diagnosed HIV-infected MSM from 2008 to 2012 in Guangzhou, China. The role of MSM in HIV-1 transmission networks was determined by a node influence measurement and centrality analysis. The association between syphilis testing and factors related to HIV-1 transmission and antiretroviral treatment (ART) were analyzed by the Cox regression model.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Among HIV-infected MSM, 56.7% did not test for syphilis at the time of HIV-1 diagnosis. MSM without syphilis testing was a specific subgroup of MSM with a larger closeness centrality and clustering coefficient than the recipients of syphilis testing (<jats:italic>P<\/jats:italic> &amp;lt; 0.001), indicating their central position in the HIV-1 transmission networks. The median degree and radiality within HIV-1 transmission networks as well as the median K-shell scores were also greater for MSM without syphilis testing (<jats:italic>P<\/jats:italic> &amp;lt; 0.001), suggesting their relatively greater contribution in transmitting HIV-1 than the receipts of syphilis testing. MSM with syphilis testing usually did not disclose their occupation or were more likely to be unemployed or to take non-skilled jobs, to have a history of sexually transmitted infections (STIs), and to be AIDS patients when diagnosed with HIV-1 infection (<jats:italic>P<\/jats:italic> &amp;lt; 0.05). Multivariable Cox regression analysis indicated that syphilis testing <jats:italic>per se<\/jats:italic> did not promote the engagement of ART (<jats:italic>P<\/jats:italic> = 0.233) or affect the speed of CD4<jats:sup>+<\/jats:sup> T cell count recovery after treatment (<jats:italic>P<\/jats:italic> = 0.256).<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Our study identifies syphilis testing as a proxy marker of a specific subgroup of HIV-infected MSM who refuse syphilis testing during HIV-1 diagnosis with an important role in HIV-1 transmission. Specific prevention and intervention targeting MSM without syphilis testing during HIV-1 care are urgently needed.<\/jats:p>","DOI":"10.3389\/fmed.2021.662689","type":"journal-article","created":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T06:24:37Z","timestamp":1625639077000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Syphilis Testing as a Proxy Marker for a Subgroup of Men Who Have Sex With Men With a Central Role in HIV-1 Transmission in Guangzhou, China"],"prefix":"10.3389","volume":"8","author":[{"given":"Liping","family":"Huang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huanchang","family":"Yan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanhao","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qingmei","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingwei","family":"Shui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhigang","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shixing","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,7,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1071\/SH14153","article-title":"Increasing trends of syphilis among men who have sex with men in high income countries","volume":"12","author":"Read","year":"2015","journal-title":"Sex Health."},{"key":"B2","unstructured":"Atlanta, GADepartment of Health and Human ServicesSexually Transmitted Disease Surveillance, 20192021"},{"key":"B3","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1093\/cid\/cit210","article-title":"HIV and syphilis prevalence among men who have sex with men: a cross-sectional survey of 61 cities in China","volume":"57","author":"Wu","year":"2013","journal-title":"Clin Infect Dis."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2075","DOI":"10.1097\/00002030-200410210-00012","article-title":"Syphilis increases HIV viral load and decreases CD4 cell counts in HIV-infected patients with new syphilis infections","volume":"18","author":"Buchacz","year":"2004","journal-title":"AIDS."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/sextrans-2020-054706","article-title":"Effect of syphilis infection on HIV acquisition: a systematic review and meta-analysis","author":"Wu","year":"2020","journal-title":"Sex Transm Infect."},{"key":"B6","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.ejim.2008.04.002","article-title":"Syphilis and HIV co-infection","volume":"20","author":"Karp","year":"2009","journal-title":"EurJ Internal Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2458-13-606","article-title":"Screen more or screen more often? 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