Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de Sao Paulo.
Laboratório Especial de Microbiologia Clínica, Universidade Federal de Sao Paulo, Escola Paulista de Medicina.
AIDS. 2019 Jan 27;33(1):77-81. doi: 10.1097/QAD.0000000000001975.
Although doxycycline is widely used as an alternative to benzathine penicillin for the treatment of early and late latent syphilis, data on serological response following treatment with doxycycline among HIV-infected patients are limited.
In this study, we analysed serological response to syphilis treatment with doxycycline among HIV-infected patients treated during a benzathine penicillin shortage period and compared with treatment response among patients treated with benzathine penicillin. Cases with neurosyphilis and those treated with suboptimal doses or with concurrent medications in association with benzathine penicillin or doxycycline were excluded.
Fifty patients treated with doxycycline from September 2014 to December 2016 were compared with 115 patients treated with benzathine penicillin for early, late latent or latent syphilis of unknown duration. Patients treated with doxycycline were slightly older [(median 49 years old, 95% confidence interval (95% CI) 43-56] than those in the penicillin group (median 44 years old, 95% CI 37-50; P = 0.007). Groups had no statistically significant differences regarding sex, HIV suppression under treatment and syphilis stages. Serological response to treatment, defined as a nonreagent Venereal Disease Research Laboratory (VDRL) or at least a four-fold reduction in VDRL titres measured 6-12 months after treatment, was seen in 72% (95% CI 58-84) of patients treated with doxycycline and 70% (95% CI 60-78) of patients treated with penicillin (P = 0.753).
We found no statistically significant differences in serological response to treatment with doxycycline or benzathine penicillin among HIV-infected patients with early, late latent or latent syphilis of unknown duration. Our findings suggest that doxycycline is an acceptable treatment to HIV-infected patients with nontertiary stages of syphilis.
虽然多西环素被广泛用作替代苄星青霉素治疗早期和晚期潜伏梅毒，但在感染 HIV 的患者中，关于多西环素治疗后的血清学反应的数据有限。
在这项研究中，我们分析了在苄星青霉素短缺期间接受多西环素治疗的 HIV 感染患者的梅毒治疗血清学反应，并将其与接受苄星青霉素治疗的患者的治疗反应进行了比较。排除神经梅毒患者以及接受剂量不足或同时使用与苄星青霉素或多西环素相关的药物的患者。
将 2014 年 9 月至 2016 年 12 月期间接受多西环素治疗的 50 例患者与 115 例接受苄星青霉素治疗的早期、晚期潜伏或潜伏期梅毒（未知持续时间）患者进行比较。接受多西环素治疗的患者年龄略大[中位数 49 岁，95%置信区间（95%CI）43-56]，而接受青霉素治疗的患者年龄中位数为 44 岁，95%CI 37-50；P=0.007]。两组在性别、治疗期间 HIV 抑制情况和梅毒分期方面无统计学差异。治疗后 6-12 个月，血清学反应定义为非反应性性病研究实验室（VDRL）或 VDRL 滴度至少降低四倍，接受多西环素治疗的患者中有 72%（95%CI 58-84），接受青霉素治疗的患者中有 70%（95%CI 60-78）（P=0.753）。
我们发现，在早期、晚期潜伏或潜伏期梅毒（未知持续时间）的 HIV 感染患者中，接受多西环素或苄星青霉素治疗的血清学反应无统计学差异。我们的研究结果表明，多西环素是治疗非三期梅毒的 HIV 感染患者的一种可接受的治疗方法。
