Lang Raynell, Read Ron, Krentz Hartmut B, Peng Mingkai, Ramazani Soheil, Vu Quang, Gill M John
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
S Alberta HIV Clinic, Alberta Health Services, Calgary, Alberta, Canada.
BMJ Open. 2018 Jul 10;8(7):e021544. doi: 10.1136/bmjopen-2018-021544.
Syphilis is a global health concern with an estimated 12 million infections occurring annually. Due to the increasing rates of new syphilis infections being reported in patients infected with HIV, and their higher risk for atypical and severe presentations, periodic screening has been recommended as a routine component of HIV care. We aimed to characterise incident syphilis presentation, serological features and treatment response in a well-defined, HIV-infected population over 11 years.
Since 2006, as routine practice of both the Southern Alberta Clinic and Calgary STI programmes, syphilis screening has accompanied HIV viral load measures every 4 months. All records of patients who, while in HIV care, either converted from being syphilis seronegative to a confirmed seropositive or were reinfected as evidenced by a fourfold increase in rapid plasma reagin (RPR) after past successful treatment, were reviewed.
We identified 249 incident syphilis infections in 194 different individuals infected with HIV; 72% were initial infections whereas 28% were reinfections. Half (50.8%) of the infections were asymptomatic and identified only by routine screening. Symptomatic syphilis was more common when RPR titres were higher (p=0.03). In patients with recurrent syphilis infection, a trend was noted favouring symptomatic presentation (62%, p=0.07). All 10 patients with central nervous system (CNS) syphilis involvement presented with an RPR titre ≥1:32. Following syphilis infection, a decline of 42 cells/mm in CD4 (p=0.004) was found, but no significant changes in viral load occurred. No association was found with the stage of syphilis or symptoms at presentation and antiretroviral therapy use, CD4 count or virological suppression.
Routine screening of our HIV-infected population identified many asymptomatic syphilis infections. The interaction of HIV and syphilis infection appears to be bidirectional with effects noted on both HIV and syphilis clinical and serological markers.
梅毒是一个全球卫生问题，估计每年有1200万例感染。由于感染艾滋病毒的患者中新发梅毒感染率不断上升，且他们出现非典型和严重症状的风险更高，因此建议定期筛查作为艾滋病毒护理的常规组成部分。我们旨在描述在一个明确界定的艾滋病毒感染人群中11年来梅毒发病表现、血清学特征和治疗反应。
自2006年以来，作为南艾伯塔诊所和卡尔加里性传播感染项目的常规做法，每4个月在检测艾滋病毒病毒载量时同时进行梅毒筛查。对所有在接受艾滋病毒护理期间梅毒血清学从阴性转为确诊阳性或在过去成功治疗后快速血浆反应素（RPR）升高四倍证明再次感染的患者记录进行审查。
我们在194名不同的艾滋病毒感染个体中确定了249例梅毒新发感染；72%为初次感染，28%为再次感染。一半（50.8%）的感染无症状，仅通过常规筛查发现。当RPR滴度较高时，有症状的梅毒更常见（p=0.03）。在复发性梅毒感染患者中，注意到有症状表现的趋势（62%，p=0.07）。所有10例有中枢神经系统（CNS）梅毒累及的患者RPR滴度均≥1:32。梅毒感染后，发现CD4下降42个细胞/mm（p=0.004），但病毒载量无显著变化。未发现梅毒分期或就诊时症状与抗逆转录病毒治疗使用、CD4计数或病毒学抑制之间存在关联。
对我们的艾滋病毒感染人群进行常规筛查发现了许多无症状梅毒感染。艾滋病毒和梅毒感染之间的相互作用似乎是双向的，对艾滋病毒和梅毒的临床及血清学标志物均有影响。
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