Factors influencing syphilis treatment failure and/or re-infection in HIV co-infected patients: immunosuppression or behaviors |
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Authors: | Kim Jong Hun Psevdos George Suh Jin Sharp Victoria |
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Institution: | 1. Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA 2. Center for Comprehensive Care, St. Luke's-Roosevelt Hospital Center, New York, USA |
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Abstract: | Background Recent studies have reported overall increasing rates of syphilis with a high rate of human immunodeficiency virus (HIV) co-infection. However, there is little information about factors influencing syphilis treatment failure and/or re-infection in HIV co-infected patients. We conducted a study to evaluate factors associated with syphilis treatment failure/re-infection in HIV co-infected patients.Methods We reviewed 3542 medical records of HIV-infected patients from January 2005 to December 2007 followed up at HIV Clinic in New York City. Patients were categorized by rapid plasma regain titer (RPR) into success/serofast (4-fold decrease in RPR by 12 months after treatment, RPR conversion to nonreactive, persistently stable reactive RPR with no 4-fold increase), and failure/re-infection (failure to decrease 4 folds in RPR by 12 months after treatment, 4-fold increase in RPR from baseline).Results Among a total of 156 patients who met the eligibility criteria, 122 (78.2%) were under success/serofast category,and 34 (21.8%) were under failure/re-infection category. HIV viral load, CD4 cell count, and use of highly active antiretroviral therapy (HAART) were not associated with syphilis treatment failure/re-infection. However, early syphilis stage (OR:11.036, 95% CI: 2.499-48.740, P=0.002) and high (>1∶64) RPR titers (OR: 715.921, 95% CI: 422.175-23 113.396, P <0.001) were significantly associated.Conclusions No correlations were seen with depressed immune states with syphilis treatment failure and/or re-infection. However, association with early stage syphilis suggests that risky psychological sexual behaviors may be the most important leading factor, emphasizing needs for safe sex education. |
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Keywords: | human immunodeficiency virus syphilis treatment failure re-infection |
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