A single dose of benzathine penicillin G is as effective as multiple doses of benzathine penicillin G for the treatment of HIV-infected persons with early syphilis.
BACKGROUND
Treatment guidelines recommend the use of a single dose of benzathine penicillin G (BPG) for treating early syphilis in human immunodeficiency virus (HIV)-infected persons. However, data supporting this recommendation are limited. We examined the efficacy of single-dose BPG in the US Military HIV Natural History Study.


METHODS
Subjects were included if they met serologic criteria for syphilis (ie, a positive nontreponemal test [NTr] confirmed by treponemal testing). Response to treatment was assessed at 13 months and was defined by a ≥4-fold decline in NTr titer. Multivariate Cox proportional hazard regression models were utilized to examine factors associated with treatment response.


RESULTS
Three hundred fifty subjects (99% male) contributed 478 cases. Three hundred ninety-three cases were treated exclusively with BPG (141 with 1 dose of BPG). Treatment response was the same among those receiving 1 or >1 dose of BPG (92%). In a multivariate analysis, older age (hazard ratio [HR], 0.82 per 10-year increase; 95% confidence interval [CI], .73-.93) was associated with delayed response to treatment. Higher pretreatment titers (reference NTr titer <1:64; HR, 1.94 [95% CI, 1.58-2.39]) and CD4 counts (HR, 1.07 for every 100-cell increase [95% CI, 1.01-1.12]) were associated with a faster response to treatment. Response was not affected by the number of BPG doses received (reference, 1 dose of BPG; HR, 1.11 [95% CI, .89-1.4]).


CONCLUSIONS
In this cohort, additional BPG doses did not affect treatment response. Our data support the current recommendations for the use of a single dose of BPG to treat HIV-infected persons with early syphilis.
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland Walter Reed National Military Medical Center, Washington, District of Columbia.
Anuradha
A
Ganesan
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Octavio
O
Mesner
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland San Antonio Military Medical Center, Texas.
Jason F
JF
Okulicz
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland San Antonio Military Medical Center, Texas.
Thomas
T
O'Bryan
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland Naval Medical Center San Diego, California.
Robert G
RG
Deiss
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland Naval Medical Center Portsmouth, Virginia.
Tahaniyat
T
Lalani
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland Walter Reed National Military Medical Center, Washington, District of Columbia.
Timothy J
TJ
Whitman
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland Walter Reed National Military Medical Center, Washington, District of Columbia.
Amy C
AC
Weintrob
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Grace
G
Macalino
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Brian K
BK
Agan
D000328:Adult; D000367:Age Factors; D000368:Aged; D000993:Antitreponemal Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010401:Penicillin G Benzathine / Q000008:administration & dosage*; D016016:Proportional Hazards Models; D013587:Syphilis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D055815:Young Adult
D000993:Antitreponemal Agents; D010401:Penicillin G Benzathine
HIV-infected persons; benzathine penicillin G; early syphilis; treatment response