title: Factors influencing syphilis treatment failure and/or re-infection in HIV co-infected patients: immunosuppression or behaviors.
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.
authors.affiliation: Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. kimj4@upmc.edu
authors.forename: Jong Hun
authors.initials: JH
authors.lastname: Kim
authors.forename: George
authors.initials: G
authors.lastname: Psevdos
authors.forename: Jin
authors.initials: J
authors.lastname: Suh
authors.forename: Victoria
authors.initials: V
authors.lastname: Sharp
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000188:drug therapy* / Q000276:immunology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013587:Syphilis / Q000188:drug therapy* / Q000276:immunology*; D017211:Treatment Failure