TY - JOUR
T1 - Incidence and predictors of serological treatment response in early and late syphilis among people living with HIV
AU - Spagnuolo, Vincenzo
AU - Poli, Andrea
AU - Galli, Laura
AU - Nozza, Silvia
AU - Bossolasco, Simona
AU - Cernuschi, Massimo
AU - Maillard, Myriam
AU - Hasson, Hamid
AU - Gianotti, Nicola
AU - Guffanti, Monica
AU - Lazzarin, Adriano
AU - Castagna, Antonella
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background Few studies have investigated predictors of serological response to syphilis treatment in people living with HIV (PLWH). Methods This was a retrospective, longitudinal study on PLWH who were diagnosed with and treated for syphilis who had an assessable serological response between January 2004 and June 2016. Serological treatment response (TR) was defined as a ≥4-fold decline in rapid plasma reagin (RPR) titers or a reversion to nonreactive (if RPR ≤1:4 at diagnosis) 12 months after treatment for early syphilis and 24 months after treatment for late syphilis. Factors associated with a TR were assessed with multivariate Cox proportional hazard models for recurrent events. Results A total of 829 episodes of syphilis (686 early, 143 late) in 564 patients were recorded. TR was observed in 732 (88%) syphilis episodes. The proportion of TR differed between early and late syphilis (89% vs 83%, respectively; P =.045). For early syphilis, TR was associated with a higher nadir CD4+ cell count (adjusted hazard ratio [AHR], 1.06; P =.029), an RPR titer >1:32 at diagnosis (AHR, 1.26; P =.009), secondary syphilis (AHR, 1.29; P =.008), and cases of syphilis diagnosed in more recent calendar years (AHR, 1.36; P <.0001). In late syphilis, TR was more likely to occur for first infections (AHR, 1.80; P =.027), for episodes that occurred in more recent years (AHR, 1.62; P =.007), and for RPR titers >1:32 at diagnosis (AHR, 2.04; P =.002). TR was not associated with the type of treatment regimen in early and late syphilis. Conclusions Higher RPR titers at diagnosis and a diagnosis of syphilis that was made in more recent years were associated with TR in early and late syphilis.
AB - Background Few studies have investigated predictors of serological response to syphilis treatment in people living with HIV (PLWH). Methods This was a retrospective, longitudinal study on PLWH who were diagnosed with and treated for syphilis who had an assessable serological response between January 2004 and June 2016. Serological treatment response (TR) was defined as a ≥4-fold decline in rapid plasma reagin (RPR) titers or a reversion to nonreactive (if RPR ≤1:4 at diagnosis) 12 months after treatment for early syphilis and 24 months after treatment for late syphilis. Factors associated with a TR were assessed with multivariate Cox proportional hazard models for recurrent events. Results A total of 829 episodes of syphilis (686 early, 143 late) in 564 patients were recorded. TR was observed in 732 (88%) syphilis episodes. The proportion of TR differed between early and late syphilis (89% vs 83%, respectively; P =.045). For early syphilis, TR was associated with a higher nadir CD4+ cell count (adjusted hazard ratio [AHR], 1.06; P =.029), an RPR titer >1:32 at diagnosis (AHR, 1.26; P =.009), secondary syphilis (AHR, 1.29; P =.008), and cases of syphilis diagnosed in more recent calendar years (AHR, 1.36; P <.0001). In late syphilis, TR was more likely to occur for first infections (AHR, 1.80; P =.027), for episodes that occurred in more recent years (AHR, 1.62; P =.007), and for RPR titers >1:32 at diagnosis (AHR, 2.04; P =.002). TR was not associated with the type of treatment regimen in early and late syphilis. Conclusions Higher RPR titers at diagnosis and a diagnosis of syphilis that was made in more recent years were associated with TR in early and late syphilis.
KW - antibiotic treatment
KW - early syphilis
KW - HIV
KW - late syphilis
KW - serological response
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U2 - 10.1093/ofid/ofy324
DO - 10.1093/ofid/ofy324
M3 - Article
AN - SCOPUS:85062425760
VL - 6
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
SN - 2328-8957
IS - 1
ER -