College of Health Sciences, School of Medicine, Department of Dermatovenerology, Addis Ababa University, Addis Ababa, Ethiopia.
College of Health Sciences, School of Medicine, Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
PLoS One. 2022 Jul 12;17(7):e0270878. doi: 10.1371/journal.pone.0270878. eCollection 2022.
We investigated people with HIV (PWH) receiving combination antiretroviral therapy (cART) for latent syphilis infection prevalence, risk factors, treatment response, and neurosyphilis.
A prospective follow-up study was conducted on PWH and latent syphilis. The cases were randomly assigned to receive either benzathine penicillin G (BPG) or doxycycline (DOXY), and the posttreatment response was evaluated after 12 and 24 months. The traditional algorithm was used for serodiagnosis, and a semi-quantitative rapid plasma reagin (RPR) test monitored disease activity and treatment effectiveness.
Of the 823 participants, 64.8% were women, and the mean age was 41.7±10 years. Thirty-one (3.8%) of the participants (22 males and nine females) had latent syphilis. The risk factors were male sex (aOR = 3.14), increasing age (aOR = 1.04 per year), and cART duration (aOR = 1.01 per month). Baseline RPR titers were: ≤1:4 in 19 (61.3%), between 1:8 and 1:32 in 10 (32.2%), and >1:32 in 2 (6.4%). None of the seven cerebrospinal fluid analyses supported a neurosyphilis diagnosis. In the 12th month of treatment, 27 (87.1%) had adequate serological responses, three (9.7%) had serological nonresponse, and one (3.2%) had treatment failure. Syphilis treatment was repeated in the last four cases with the alternative drug. In terms of adequate serologic response, both therapies were comparable at the 12th month, p = 0.37. All cases responded to treatment in the 24th month.
In PWH receiving cART, latent syphilis occurred more in men than women, suggesting an investigation of sexual practices and the impact of antenatal syphilis screening. Syphilis disease activity reduces in the latent stage. Therefore, the routine cerebrospinal fluid analysis contributes little to the diagnosis of asymptomatic neurosyphilis and the treatment success of latent syphilis. DOXY is an alternative to BPG, and cART improves serologic response to latent syphilis treatment.
我们研究了接受联合抗逆转录病毒治疗（cART）的艾滋病毒（HIV）感染者（PWH）中潜伏梅毒感染的患病率、危险因素、治疗反应和神经梅毒。
对 PWH 和潜伏梅毒进行了前瞻性随访研究。将病例随机分为苄星青霉素 G（BPG）或多西环素（DOXY）治疗组，并在治疗后 12 个月和 24 个月评估治疗后反应。采用传统的血清学诊断算法，半定量快速血浆反应素（RPR）试验监测疾病活动和治疗效果。
823 名参与者中，64.8%为女性，平均年龄为 41.7±10 岁。31 名（3.8%）参与者（22 名男性和 9 名女性）患有潜伏梅毒。危险因素为男性（优势比[OR] = 3.14）、年龄增长（OR = 1.04/年）和 cART 持续时间（OR = 1.01/月）。基线 RPR 滴度分别为：≤1：4 有 19 例（61.3%），1：8 至 1：32 有 10 例（32.2%），>1：32 有 2 例（6.4%）。七例脑脊液分析均未支持神经梅毒的诊断。治疗 12 个月时，27 例（87.1%）有足够的血清学反应，3 例（9.7%）有血清学无反应，1 例（3.2%）有治疗失败。后四例用替代药物重复梅毒治疗。在 12 个月时，两种治疗方法的充分血清学反应相当，p = 0.37。所有病例在 24 个月时均对治疗有反应。
在接受 cART 的 PWH 中，潜伏梅毒在男性中比女性更常见，这提示需要调查性行为和产前梅毒筛查的影响。梅毒在潜伏阶段时疾病活动减少。因此，常规的脑脊液分析对无症状神经梅毒的诊断和潜伏梅毒治疗的疗效帮助不大。DOXY 是 BPG 的替代药物，cART 可改善潜伏梅毒治疗的血清学反应。
