title: Clinical and serologic baseline and follow-up features of syphilis according to HIV status in the post-HAART era.
abstract: There is a lack of large studies appraising the effect of the human immunodeficiency virus (HIV) on the course of syphilis since the advent of highly active antiretroviral therapy (HAART). We aimed to appraise the effect of HIV on clinical and serologic features of syphilis at baseline and during follow-up in the post-HAART era.We designed a retrospective cohort study of consecutive syphilis cases, diagnosed between 2000 and 2007, in an academic venereal disease center. Data were collected using standardized medical forms. Patients were treated according to the European guidelines. Serologic failure was defined as either a 4-fold rise in Venereal Disease Research Laboratory (VDRL) titers 30-400 days posttreatment or a lack of 4-fold drop in VDRL titers at 270-400 days posttreatment.Among 279 syphilis cases with informative baseline clinical and serologic data, HIV infection was significantly associated with men having sex with men, French origin, multiple partners, lesser usage of condom, history of sexually transmitted disease, early syphilis, anal primary chancre, and cutaneous eruption. Median baseline titer from the Treponema pallidum hemagglutination assay (TPHA) was higher in HIV-infected patients (p = 0.02).Among 144 informative syphilis cases, there was a nonsignificant trend for a lower rate of serologic response among HIV-positive patients (91.8% vs. 98.3%, p = 0.14). Serologic failure was significantly associated with a history of previous syphilis (p < 0.05). The median delay to serologic response was similar in HIV-positive (117 d) and in HIV-negative (123 d) patients (p = 0.44).We conclude that for patients under HAART treatment, the effect of HIV on serologic response to syphilis treatment is likely minimal or absent.
authors.affiliation: From Department of Dermatology and Venereology (DF, NZ, JD, JPM, PG, MFA, ND), Hôpital Cochin-Pavillon Tarnier, AP-HP, Université Paris 5-René Descartes, Paris; Department of Bacteriology (NB), Hôpital Cochin, AP-HP, Université Paris 5, Paris; Laboratoire de Recherche en Dermatologie et Centre National de Référence de la Syphilis (PG, ND), UPRES EA 1833, Université Paris 5-René Descartes, Paris; Department of Virology (AK), Hôpital Saint-Vincent de Paul, AP-HP, Université Paris 5, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Farhi
authors.forename: Nadjet
authors.initials: N
authors.lastname: Benhaddou
authors.forename: Philippe
authors.initials: P
authors.lastname: Grange
authors.forename: Nada
authors.initials: N
authors.lastname: Zizi
authors.forename: Jean
authors.initials: J
authors.lastname: Deleuze
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Morini
authors.forename: Philippe
authors.initials: P
authors.lastname: Gerhardt
authors.forename: Anne
authors.initials: A
authors.lastname: Krivine
authors.forename: Marie-Françoise
authors.initials: MF
authors.lastname: Avril
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dupin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013587:Syphilis / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D013588:Syphilis Serodiagnosis; D055815:Young Adult