AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo.
AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo Center for AIDS Research, Kumamoto University, Japan.
Clin Infect Dis. 2015 Jul 15;61(2):177-83. doi: 10.1093/cid/civ270. Epub 2015 Mar 31.
Intramuscular benzathine penicillin G (BPG) is widely used for the treatment of syphilis. However, BPG is not available in some countries. This study examined the effectiveness and safety of high-dose oral amoxicillin plus probenecid for the treatment of syphilis in patients with human immunodeficiency virus type 1 (HIV-1).
This retrospective observational study included 286 HIV-infected male patients with syphilis (median age, 36 years; median CD4 count, 389 cells/µL) who were treated with oral amoxicillin 3 g plus probenecid. Syphilis was diagnosed by both serum rapid plasma reagin (RPR) titers ≥8 and positive Treponema pallidum hemagglutination test. Patients with neurosyphilis diagnosed by cerebrospinal fluid examination were excluded. Successful treatment was defined as a at least 4-fold decrement in RPR titer.
The overall treatment efficacy was 95.5% (95% confidence interval [CI], 92.4%-97.7%; 273/286 patients), and efficacy for primary, secondary, early latent, late latent, and unknown duration syphilis was 93.8% (95% CI, 68.1%-99.8%; 15/16), 97.3% (95% CI, 92.9%-99.2%; 142/146), 100% (95% CI, 90.5%-100%; 37/37), 85.7% (95% CI, 58.6%-96.4%; 18/21), and 92.4% (95% CI, 81.9%-97.3%; 61/66), respectively. Treatment duration was mostly 14-16 days (49.7%) or 28-30 days (34.3%), with efficacy of 94.4% (134/142) and 95.9% (94/98), respectively; 96.3% of successfully treated patients achieved a ≥4-fold decrement in RPR titer within 12 months. Adverse events were noted in 28 (9.8%) patients, and 25 of these (89.3%) were successfully treated. Only 6% of patients underwent lumbar puncture.
The combination of oral amoxicillin 3 g plus probenecid was highly effective and tolerable for the treatment of syphilis in patients with HIV-1 infection.
肌内注射苄星青霉素 G（BPG）被广泛用于治疗梅毒。然而，在一些国家BPG 并不供应。本研究旨在评估大剂量口服阿莫西林加丙磺舒治疗人类免疫缺陷病毒 1 型（HIV-1）感染患者梅毒的有效性和安全性。
这是一项回顾性观察性研究，纳入了 286 例 HIV 感染的男性梅毒患者（中位年龄 36 岁；中位 CD4 计数 389 个/µL），他们接受了口服阿莫西林 3 g 加丙磺舒治疗。梅毒的诊断依据是血清快速血浆反应素（RPR）滴度≥8 和梅毒螺旋体血凝试验阳性。排除通过脑脊液检查诊断为神经梅毒的患者。成功治疗定义为 RPR 滴度至少下降 4 倍。
总体治疗有效率为 95.5%（95%置信区间[CI]：92.4%-97.7%；273/286 例患者），一期、二期、早期潜伏、晚期潜伏和未知持续时间梅毒的有效率分别为 93.8%（95%CI：68.1%-99.8%；15/16 例）、97.3%（95%CI：92.9%-99.2%；142/146 例）、100%（95%CI：90.5%-100%；37/37 例）、85.7%（95%CI：58.6%-96.4%；18/21 例）和 92.4%（95%CI：81.9%-97.3%；61/66 例）。治疗时间主要为 14-16 天（49.7%）或 28-30 天（34.3%），有效率分别为 94.4%（134/142 例）和 95.9%（94/98 例）；96.3%的成功治疗患者在 12 个月内 RPR 滴度下降≥4 倍。28 例（9.8%）患者出现不良反应，其中 25 例（89.3%）成功治疗。仅 6%的患者接受了腰椎穿刺。
口服阿莫西林 3 g 加丙磺舒联合治疗 HIV-1 感染患者梅毒疗效高且耐受性好。
