Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, and Chinese Academy of Medical Sciences, Beijing, China.
Tsinghua-Peking Center for Life Sciences, Beijing, China.
Front Public Health. 2024 Jan 15;11:1327896. doi: 10.3389/fpubh.2023.1327896. eCollection 2023.
This study aims to analyze the efficacy of anti-syphilis treatment and the impact of syphilis events on HIV virology and immunology in HIV/syphilis co-infected patients on long-term antiretroviral therapy (ART) and to investigate the incidence and factors of syphilis recurrence/re-infection/serofast state. The insights derived from this investigation can potentially guide strategies for preventing and managing syphilis and AIDS.
A retrospective case-control study was conducted at the AIDS clinic of Peking Union Medical College Hospital from January 2003 to December 2022. The study involved 86 HIV/syphilis co-infected patients and 86 HIV mono-infected patients matched based on age, baseline CD4 + T cell counts, and viral load. We examined the clinical characteristics of HIV/syphilis co-infected patients, evaluated the efficacy of anti-syphilis treatment, and analyzed the dynamic changes in HIV virology and immunology. The Generalized Estimating Equations (GEE) model investigated the factors associated with HIV/syphilis co-infection and syphilis recurrence/reinfection/serofast state.
Syphilis serofast state was observed in 11.6% (10/86) of HIV/syphilis co-infected patients after treatment, and 33.7% (29/86) had syphilis recurrence or re-infection. The overall effectiveness of syphilis treatment stood at 76.8% (63/82). Notably, the effectiveness of syphilis treatment displayed a significant correlation with baseline syphilis titers exceeding 1:128 ( = 0.003). Over the 10-year follow-up period on ART, the HLA-DR + CD8+/CD8 + % levels in the HIV/syphilis co-infected group were markedly higher than those in the HIV mono-infected group ( < 0.05). However, no significant differences were observed between the two groups regarding HIV viral load, CD4+ T cell counts, CD8+ T cell counts, CD4/CD8 ratio, and CD38 + CD8+/CD8 + % ( > 0.05). GEE analysis model revealed that elevated HLA-DR + CD8+/CD8 + % levels were associated with HIV/syphilis co-infection (OR = 1.026, 95% CI = 1.007-1.046; = 0.007) and syphilis recurrence/reinfection/serofast state (OR = 1.036, 95% CI = 1.008-1.065; = 0.012).
While HIV/syphilis co-infected patients typically receive adequate treatment, the incidence of syphilis recurrence and reinfection remain notably elevated. A heightened HLA-DR + CD8+/CD8+ % is a notable risk factor for HIV/syphilis co-infection and syphilis recurrence/reinfection/serofast state. Therefore, it is advisable to reinforce health education efforts and ensure regular follow-ups for people living with HIV undergoing ART to monitor syphilis infection or increased risk of syphilis infection.
本研究旨在分析长期抗逆转录病毒治疗（ART）的 HIV/梅毒合并感染患者的抗梅毒治疗效果，以及梅毒事件对 HIV 病毒学和免疫学的影响，并探讨梅毒复发/再感染/血清固定状态的发生率和相关因素。本研究的结果可为梅毒和艾滋病的预防和管理策略提供参考。
回顾性病例对照研究，于 2003 年 1 月至 2022 年 12 月在北京大学第一医院 AIDS 门诊进行。共纳入 86 例 HIV/梅毒合并感染患者和 86 例 HIV 单一感染患者，根据年龄、基线 CD4+T 细胞计数和病毒载量进行匹配。我们观察了 HIV/梅毒合并感染患者的临床特征，评估了抗梅毒治疗效果，并分析了 HIV 病毒学和免疫学的动态变化。采用广义估计方程（GEE）模型探讨了 HIV/梅毒合并感染和梅毒复发/再感染/血清固定状态的相关因素。
治疗后，86 例 HIV/梅毒合并感染患者中有 11.6%（10/86）出现梅毒血清固定状态，33.7%（29/86）出现梅毒复发或再感染。总的梅毒治疗有效率为 76.8%（63/82）。值得注意的是，梅毒治疗的有效性与基线梅毒滴度超过 1:128 显著相关（ = 0.003）。在 ART 治疗 10 年的随访期间，HIV/梅毒合并感染组的 HLA-DR+CD8+/CD8+%水平明显高于 HIV 单一感染组（ < 0.05）。然而，两组间 HIV 病毒载量、CD4+T 细胞计数、CD8+T 细胞计数、CD4/CD8 比值和 CD38+CD8+/CD8+%均无显著差异（ > 0.05）。GEE 分析模型显示，升高的 HLA-DR+CD8+/CD8+%水平与 HIV/梅毒合并感染（OR=1.026，95%CI=1.007-1.046； = 0.007）和梅毒复发/再感染/血清固定状态（OR=1.036，95%CI=1.008-1.065； = 0.012）相关。
尽管 HIV/梅毒合并感染患者通常接受了充分的治疗，但梅毒复发和再感染的发生率仍然显著升高。升高的 HLA-DR+CD8+/CD8+%是 HIV/梅毒合并感染和梅毒复发/再感染/血清固定状态的显著危险因素。因此，建议加强对接受 ART 的 HIV 感染者的健康教育，并确保定期随访，以监测梅毒感染或梅毒感染风险增加的情况。
