Janier M, Chastang C, Spindler E, Strazzi S, Rabian C, Marcelli A, Morel P
Sexually Transmitted Diseases Clinic, Hôpital Saint-Louis, Paris, France.
Dermatology. 1999;198(4):362-9. doi: 10.1159/000018149.
The evolution of serological tests for syphilis (STSs) after therapy in HIV+ patients is a major point of controversy, with possible seroreactivation and illicit seroreversion in these patients. The aim of our study was to evaluate the long-term outcome of STSs in a cohort of HIV+ male homosexuals with a history of treated syphilis as compared with HIV- controls.
Sixty-nine HIV+ male homosexuals with a documented history of treated syphilis and positive baseline treponemal tests were prospectively studied between 1986 and 1993. A medical examination, HIV staging, CD4+ cell count, VDRL, FTA-Abs tests and TPHA were performed every 6 months. Controls consisted of 49 HIV- patients with similar inclusion criteria over the same period. Comparisons between subgroups were based on chi(2) and Kruskal-Wallis tests. Analysis of negativation of the STS used the failure data methods (Kaplan-Meier, log-rank and Cox's model).
Patients had a mean age of 38 years, a baseline CD4+ cell count of 578/mm(3), elapsed time since last syphilis of 7.5 years and a median follow-up of 4.3 years. Controls had a mean age of 42 years, elapsed time since last syphilis of 5.3 years and a median follow-up of 4.7 years. Time to seroreversion was shorter in HIV+ patients for TPHA (p = 0.009, log-rank test) and FTA-Abs test (p = 0.001, log-rank test), even after adjustment for stage of syphilis, age and time since the last episode of syphilis. The decrease in VDRL titres was not different between the 2 groups (p = 0.053, log-rank test). Seroreversion of the TPHA, FTA-Abs test and VDRL test was not significantly related to stage of syphilis, time elapsed since the last episode of syphilis, age or history of STDs in both groups. Seroreversion of the TPHA and VDRL test was not related to baseline CD4+ cell count. However, seroreversion of the FTA-Abs test was related to a low baseline CD4+ cell count (p = 0. 003). In HIV+ patients, a significant decrease in titres was noticed for TPHA, FTA-Abs test and VDRL test over time, but this time effect remained only for TPHA titres after adjustment for the CD4+ cell count.
TPHA may serorevert in HIV+ patients. Thus, a non-reactive TPHA does not exclude a past syphilis infection in such patients. Evolution of the VDRL test after therapy is regular in HIV+ patients. The VDRL test remains adequate for controlling the efficacy of treatment in these patients.
梅毒血清学检测（STSs）在接受治疗的HIV阳性患者中的演变是一个主要争议点，这些患者可能会出现血清学再激活和非法血清学逆转。我们研究的目的是评估一组有梅毒治疗史的HIV阳性男性同性恋者与HIV阴性对照者相比，STSs的长期结果。
1986年至1993年对69名有梅毒治疗记录且梅毒螺旋体试验基线阳性的HIV阳性男性同性恋者进行前瞻性研究。每6个月进行一次医学检查、HIV分期、CD4+细胞计数、VDRL、FTA - Abs试验和TPHA。对照组由同期49名符合类似纳入标准的HIV阴性患者组成。亚组间比较基于卡方检验和Kruskal - Wallis检验。STSs转阴分析采用失效数据方法（Kaplan - Meier、对数秩和Cox模型）。
患者平均年龄38岁，基线CD4+细胞计数为578/mm³，距上次梅毒感染时间为7.5年，中位随访时间为4.3年。对照组平均年龄42岁，距上次梅毒感染时间为5.3年，中位随访时间为4.7年。即使在调整梅毒分期、年龄和距上次梅毒发作时间后，HIV阳性患者中TPHA（p = 0.009，对数秩检验）和FTA - Abs试验（p = 0.001，对数秩检验）血清学逆转时间较短。两组间VDRL滴度下降无差异（p = 0.053，对数秩检验）。两组中TPHA、FTA - Abs试验和VDRL试验的血清学逆转与梅毒分期、距上次梅毒发作时间、年龄或性传播疾病史均无显著相关性。TPHA和VDRL试验的血清学逆转与基线CD4+细胞计数无关。然而，FTA - Abs试验的血清学逆转与低基线CD4+细胞计数有关（p = 0.003）。在HIV阳性患者中，随着时间推移，TPHA、FTA - Abs试验和VDRL试验的滴度显著下降，但在调整CD4+细胞计数后，这种时间效应仅在TPHA滴度中存在。
HIV阳性患者中TPHA可能会血清学逆转。因此，对于此类患者，TPHA阴性并不能排除既往梅毒感染。HIV阳性患者治疗后VDRL试验的演变是规律的。VDRL试验对于控制这些患者的治疗效果仍然足够。
