Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Sex Transm Dis. 2010 Jan;37(1):53-8. doi: 10.1097/OLQ.0b013e3181b6f0cc.
Syphilis rates are rising in California, but the impact of HIV infection on syphilis infection remains uncertain. We describe differences between HIV-infected and HIV-uninfected patients diagnosed with syphilis within Kaiser Permanente Northern California.
We performed retrospective analyses of patients diagnosed with incident syphilis from 1995 to 2005 (622 cases/9989 HIV-infected patients and 3584/4,442,780 HIV-uninfected). Among cases, we ascertained demographic, clinical characteristics, and laboratory (including baseline labs and repeated RPR titers) data. We performed Poisson regression (incidence) and Cox proportional hazard modeling (reduction in RPR and serologic failure after syphilis therapy) adjusting for age, gender, and HIV status and among HIV-infected cases only by use of antiretroviral therapy (ART).
HIV-infected patients had incident syphilis rates of 62.3/1000 person-years compared with 0.8/1000 HIV-uninfected patients, corresponding to an adjusted rate ratio of 86.0 (P <0.001); rate differences increased significantly over time. HIV-infected patients had a greater likelihood of reduction in RPR and serologic failure after syphilis therapy (HR = 2.5 and 2.6 respectively [P <0.001 both]). Among HIV-infected only, patients on ART had lower rates of infection but higher likelihood of reduction in RPR after syphilis therapy and serologic failure compared with patients not on ART.
HIV-infected patients had greater rate of incident syphilis compared with HIV-uninfected, a disparity which increased over time. HIV-infected patients had greater likelihood of decline in RPR and serologic failure. HIV-infected patients should be screened for syphilis regularly.
加利福尼亚州梅毒发病率正在上升，但 HIV 感染对梅毒感染的影响仍不确定。我们描述了 Kaiser Permanente 北加利福尼亚州内诊断患有梅毒的 HIV 感染者和 HIV 未感染者之间的差异。
我们对 1995 年至 2005 年间诊断患有梅毒的患者进行了回顾性分析（622 例/9989 例 HIV 感染者和 3584 例/4442780 例 HIV 未感染者）。在病例中，我们确定了人口统计学、临床特征和实验室数据（包括基线实验室和重复 RPR 滴度）。我们进行了泊松回归（发病率）和 Cox 比例风险模型（梅毒治疗后 RPR 降低和血清学失败率）调整，调整因素为年龄、性别和 HIV 状态，以及仅在 HIV 感染者中使用抗逆转录病毒疗法（ART）。
HIV 感染者的梅毒发病率为 62.3/1000 人年，而 HIV 未感染者为 0.8/1000 人年，调整后的发病率比为 86.0（P<0.001）；随着时间的推移，发病率差异显著增加。HIV 感染者在梅毒治疗后 RPR 降低和血清学失败的可能性更大（HR 分别为 2.5 和 2.6[均 P<0.001]）。在仅 HIV 感染者中，与未接受 ART 的患者相比，接受 ART 的患者感染率较低，但梅毒治疗后 RPR 降低和血清学失败的可能性更高。
与 HIV 未感染者相比，HIV 感染者的梅毒发病率更高，且这种差异随着时间的推移而增加。HIV 感染者更有可能降低 RPR 和血清学失败的可能性。HIV 感染者应定期筛查梅毒。
