Farhi David, Benhaddou Nadjet, Grange Philippe, Zizi Nada, Deleuze Jean, Morini Jean-Pierre, Gerhardt Philippe, Krivine Anne, Avril Marie-Françoise, Dupin Nicolas
From Department of Dermatology and Venereology (DF, NZ, JD, JPM, PG, MFA, ND), Hôpital Cochin-Pavillon Tarnier, AP-HP, Université Paris 5-René Descartes, Paris; Department of Bacteriology (NB), Hôpital Cochin, AP-HP, Université Paris 5, Paris; Laboratoire de Recherche en Dermatologie et Centre National de Référence de la Syphilis (PG, ND), UPRES EA 1833, Université Paris 5-René Descartes, Paris; Department of Virology (AK), Hôpital Saint-Vincent de Paul, AP-HP, Université Paris 5, Paris, France.
Medicine (Baltimore). 2009 Nov;88(6):331-340. doi: 10.1097/MD.0b013e3181c2af86.
There is a lack of large studies appraising the effect of the human immunodeficiency virus (HIV) on the course of syphilis since the advent of highly active antiretroviral therapy (HAART). We aimed to appraise the effect of HIV on clinical and serologic features of syphilis at baseline and during follow-up in the post-HAART era.We designed a retrospective cohort study of consecutive syphilis cases, diagnosed between 2000 and 2007, in an academic venereal disease center. Data were collected using standardized medical forms. Patients were treated according to the European guidelines. Serologic failure was defined as either a 4-fold rise in Venereal Disease Research Laboratory (VDRL) titers 30-400 days posttreatment or a lack of 4-fold drop in VDRL titers at 270-400 days posttreatment.Among 279 syphilis cases with informative baseline clinical and serologic data, HIV infection was significantly associated with men having sex with men, French origin, multiple partners, lesser usage of condom, history of sexually transmitted disease, early syphilis, anal primary chancre, and cutaneous eruption. Median baseline titer from the Treponema pallidum hemagglutination assay (TPHA) was higher in HIV-infected patients (p = 0.02).Among 144 informative syphilis cases, there was a nonsignificant trend for a lower rate of serologic response among HIV-positive patients (91.8% vs. 98.3%, p = 0.14). Serologic failure was significantly associated with a history of previous syphilis (p < 0.05). The median delay to serologic response was similar in HIV-positive (117 d) and in HIV-negative (123 d) patients (p = 0.44).We conclude that for patients under HAART treatment, the effect of HIV on serologic response to syphilis treatment is likely minimal or absent.
自高效抗逆转录病毒疗法（HAART）问世以来，缺乏大型研究评估人类免疫缺陷病毒（HIV）对梅毒病程的影响。我们旨在评估HIV对HAART时代梅毒患者基线及随访期间临床和血清学特征的影响。我们设计了一项回顾性队列研究，纳入2000年至2007年间在一家学术性性病中心连续诊断的梅毒病例。数据通过标准化医疗表格收集。患者按照欧洲指南接受治疗。血清学治疗失败定义为治疗后30 - 400天性病研究实验室（VDRL）滴度升高4倍，或治疗后270 - 400天VDRL滴度未下降4倍。在279例具有基线临床和血清学信息的梅毒病例中，HIV感染与男男性行为、法国血统、多个性伴侣、较少使用避孕套、性传播疾病史、早期梅毒、肛门初疮和皮疹显著相关。HIV感染患者梅毒螺旋体血凝试验（TPHA）的基线滴度中位数较高（p = 0.02）。在144例有信息的梅毒病例中，HIV阳性患者血清学反应率较低，但差异无统计学意义（91.8%对98.3%，p = 0.14）。血清学治疗失败与既往梅毒病史显著相关（p < 0.05）。HIV阳性患者（117天）和HIV阴性患者（123天）血清学反应的中位延迟时间相似（p = 0.44）。我们得出结论，对于接受HAART治疗的患者，HIV对梅毒治疗血清学反应的影响可能极小或不存在。
