Syphilis predicts HIV incidence among men and transgender women who have sex with men in a pre-exposure prophylaxis trial. Syphilis infection may potentiate transmission of HIV. We sought to determine the extent to which HIV acquisition was associated with syphilis infection within an HIV pre-exposure prophylaxis trial (iPrEx) and whether Emtricitabine/Tenofovir (FTC/TDF) modified that association. The Pre-exposure Prophylaxis Initiative (iPrEx) study randomly assigned 2499 HIV-seronegative men and transgender women who have sex with men (MSM) to receive oral daily TDF coformulated with emtricitabine (FTC/TDF) or placebo. Syphilis prevalence at screening and incidence during follow-up were measured. Hazard ratios for the effect of incident syphilis on HIV acquisition were calculated. The effect of FTC/TDF on incident syphilis and HIV acquisition was assessed.
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