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M9650023.TXT
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1996-03-09
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Document 0023
DOCN M9650023
TI Serologic response to treatment of syphilis in patients with HIV
infection.
DT 9605
AU Yinnon AM; Coury-Doniger P; Polito R; Reichman RC; Infectious Diseases
Unit, University of Rochester Medical Center,; NY, USA.
SO Arch Intern Med. 1996 Feb 12;156(3):321-5. Unique Identifier : AIDSLINE
MED/96163313
AB BACKGROUND: Much controversy exists concerning the manifestations,
therapy, and response to treatment of syphilis in patients coinfected
with the human immunodeficiency virus (HIV). OBJECTIVE: To assess the
effect of HIV infection on the serologic response to treatment of
patients with syphilis. METHODS: Sixty-four HIV-seropositive patients
with syphilis were matched with 64 patients with syphilis who were HIV
negative. Matching criteria included age (+/- 5 years), sex, race,
initial rapid plasma reagin (RPR) titer (+/- 1 dilution), and stage of
syphilis at entry. There were 26 matched patients with early syphilis,
26 matched patients with late syphilis, and 12 matched patients with
biological false-positive RPR. The HIV-positive patients with early
syphilis received three doses of penicillin G benzathine. All other
patients received treatment as recommended by the Centers for Disease
Control and Prevention, Atlanta, Ga. Our study's major end points were
clinical and serologic response to treatment. RESULTS: All 16 patients
with symptomatic syphilis were cured. No patient developed clinical
signs of neurosyphilis during the 12-month follow-up period. Twenty-nine
(56%) of 52 HIV-positive patients with early or late syphilis did not
have a fourfold decrease in RPR titer 6 months after treatment compared
with 20 (38%) of 52 matched controls (P = .06). No unique
characteristics identifying patients who did not respond serologically
could be established. The HIV-positive patients with initial RPR less
than 1:32 experienced a significantly slower decrease in RPR at 12
months than did the controls (P < .001). CONCLUSIONS: Patients with
syphilis who are HIV positive are less likely to experience serologic
improvement after recommended therapy than are patients with syphilis
who are HIV negative. Patients with HIV infection who contract syphilis
should receive intensive and prolonged follow-up, and consideration
should be given to designing alternative regimens.
DE Adult Case-Control Studies Female Human HIV
Infections/*COMPLICATIONS Male Penicillin G, Benzathine/THERAPEUTIC
USE Syphilis/COMPLICATIONS/*DIAGNOSIS/DRUG THERAPY/IMMUNOLOGY Syphilis
Serodiagnosis Treatment Outcome JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).