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Ciccarese G, Facciorusso A, Mastrolonardo M, Herzum A, Parodi A, Drago F. Atypical Manifestations of Syphilis: A 10-Year Retrospective Study. J Clin Med 2024; 13:1603. [PMID: 38541829 PMCID: PMC10971508 DOI: 10.3390/jcm13061603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/24/2024] [Accepted: 02/28/2024] [Indexed: 07/24/2024] Open
Abstract
Background: The incidence of syphilis has increased in high-income countries in the past few decades, especially among men who have sex with men. In the present study, we aimed to analyze the correlations between atypical syphilis manifestations and the demographic, clinical, and laboratory features of patients and to review unusual presentations of syphilis reported in the literature. Methods: We conducted a retrospective analysis of 307 patients with syphilis diagnosed between 1 January 2013 and 31 October 2023 at the sexually transmitted infection (STI) centers of the University of Genoa and University of Foggia with both typical and atypical manifestations of disease. Results: In our series, atypical manifestations were detected in 25.8% of the patients, especially in the secondary stage of the disease. Lesions with annular morphology and lesions presenting as itchy erythematous scaly plaques with a psoriasiform appearance were the most common atypical presentations of secondary syphilis. A statistical analysis revealed that homosexual orientation, syphilis reinfection, and venereal disease research laboratory (VDRL) titers > 1:32 were correlated with atypical manifestations. Conclusions: Our study demonstrates that the spectrum of syphilis manifestations, in all the stages of the disease, is wide; atypical manifestations often pose diagnostic challenges, may delay the provision of appropriate treatment, and facilitate the spread of the infection.
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Affiliation(s)
- Giulia Ciccarese
- Section of Dermatology, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy; (G.C.); (M.M.)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, 00161 Foggia, Italy;
| | - Mario Mastrolonardo
- Section of Dermatology, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy; (G.C.); (M.M.)
| | - Astrid Herzum
- Dermatology Unit, IRCCS Giannina Gaslini, 16147 Genova, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences, University of Genoa, IRCCS—Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.P.); (F.D.)
| | - Francesco Drago
- Section of Dermatology, Department of Health Sciences, University of Genoa, IRCCS—Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.P.); (F.D.)
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Gani AH, Saleh NA, Selvam SB, Azwa I. Prevalence, risk factors and treatment outcomes of syphilis among people living with human immunodeficiency virus at primary care clinics in Malaysia: A retrospective study. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2024; 19:13. [PMID: 38496768 PMCID: PMC10944645 DOI: 10.51866/oa.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Introduction Syphilis and human immunodeficiency virus (HIV) coinfection is a common clinical problem with a significant rising trend worldwide. In Malaysia, the burden of care is shared between hospitals and primary care clinics. This study aimed to determine the prevalence of syphilis among people living with HIV (PLHIV) at primary care clinics in Malaysia and assess its association with sociodemographic characteristics, risk factors and treatment outcomes. Methods This retrospective study included 750 PLHIV aged ≥18 years who attended primary care clinics in three different locations in Malaysia from 1 January 2017 to 31 December 2019. Data were obtained from the patients' clinical notes using a structured questionnaire evaluating the sociodemographic characteristics, history of sexual and lifestyle behaviours, diagnosis and management. Results The patients' age ranged from 18 to 78 years (mean=34.7, standard deviation=10.2). The prevalence of syphilis among the PLHIV at the three primary care clinics was 33.8% (n=254). Syphilis was significantly associated with gender (P=0.038) as well as sexual activity (P<0.001), substance use (P=0.038), history of chemsex (P=0.001) and history of sexually transmitted infections (STIs) (P<0.001) within the past 12 months. The majority of the PLHIV with syphilis received treatment at the primary care clinics (n=248, 97.3%), and up to 96.1% (n=245) had completed such treatment. Conclusion Syphilis is prevalent among PLHIV at primary care clinics, and most patients receive standard treatment. Therefore, primary care doctors must enhance their knowledge to effectively manage STIs, especially syphilis.
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Affiliation(s)
- Abdul Hafiz Gani
- MBBS, MFamMed, MRCGP, MSc, CMID, Klinik Kesihatan Mahmoodiah, Jalan Mahmoodiah, Johor Bahru, Johor, Malaysia.
| | - Narul Aida Saleh
- MBBS, MFamMed, Klinik Kesihatan Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Sheela Bai Selvam
- MBBS, MFamMed, Klinik Kesihatan Cheras, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia
| | - Iskandar Azwa
- MBChB, FRCP, Dip GUM, Dip HIV, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Bromberg DJ, Mayer KH, Altice FL. Identifying and managing infectious disease syndemics in patients with HIV. Curr Opin HIV AIDS 2020; 15:232-242. [PMID: 32487816 PMCID: PMC7376494 DOI: 10.1097/coh.0000000000000631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We will present recent articles focusing on HIV synergistic interactions with other sexually transmitted infections, tuberculosis, and hepatitis, as well as recent advances in the study of social and behavioral determinants that facilitate this clustering of infectious disease. For each synergistic interaction, we highlight evidence-based interventions that clinicians and policymakers should consider to tackle HIV and infectious disease syndemics. RECENT FINDINGS Significant advances in understanding the behavioral and structural determinants of HIV and other infectious disease synergisms have been made in the past years. Intervention strategies based on these new models have also been developed. It is now well understood that treating infectious disease syndemics will require a multidisciplinary and multipronged approach. SUMMARY HIV is synergistic with multiple other infectious diseases because the risk behaviors that lead to HIV acquisition may be similar to the other infections. The influence of HIV on the other infection may be due to immunosuppression associated with disease progression resulting in increased susceptibility (e.g., HIV and tuberculosis), especially when patients are not virologically suppressed using antiretroviral therapy. In reverse, another infectious disease may, when not treated, influence HIV disease progression. Social/structural determinants like homelessness, mass incarceration, and structural discrimination precipitate psychiatric comorbidity, substance use, and risky sex behavior which lead to the spread and co-occurrence of infectious disease.
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Affiliation(s)
- Daniel J Bromberg
- Department of Social and Behavioral Sciences, Yale University School of Public Health
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Frederick L Altice
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
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Motswaledi HM. Common dermatological conditions in the HIV patient. S Afr Fam Pract (2004) 2019. [DOI: 10.1080/20786190.2019.1610234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- HM Motswaledi
- Department of Dermatology, Sefako Makgatho Health Sciences University
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5
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Katz AR, Komeya AY, Tomas JE. False-negative syphilis treponemal enzyme immunoassay results in an HIV-infected case-patient. Int J STD AIDS 2016; 28:735-737. [PMID: 27956647 DOI: 10.1177/0956462416684426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a case report of a false-negative syphilis treponemal enzyme immunoassay test result in an HIV-infected male. While treponemal tests are widely considered to be more sensitive and specific than non-treponemal tests, our findings point to potential challenges using the reverse sequence syphilis screening algorithm.
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Affiliation(s)
- Alan R Katz
- 1 Office of Public Health Studies, University of Hawaii, Honolulu, HI, USA.,2 Diamond Head STD Clinic, Hawaii Department of Health, Honolulu, HI, USA
| | - Alan Y Komeya
- 2 Diamond Head STD Clinic, Hawaii Department of Health, Honolulu, HI, USA
| | - Juval E Tomas
- 2 Diamond Head STD Clinic, Hawaii Department of Health, Honolulu, HI, USA
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6
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Kadochnikov DS, Polianskiĭ DA, Minaeva PV. [The peculiarities of the evaluation of the severity of the harm to health in the case of development of psychic problems associated with the concomitant HIV infection and the accompanying infectious pathology]. Sud Med Ekspert 2016; 59:7-12. [PMID: 27030090 DOI: 10.17116/sudmed20165917-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of the present study was to elaborate the qualifying criteria for the evaluation of the severity of the harm to health in the case of development of a psychic disease associated with the concomitant HIV infection and the accompanying infectious pathology, in the first place tuberculosis, venereal diseases, parenteral hepatitis B and C. The scientifically substantiated qualifying criteria are proposed to be used for the expert assessment of the harm to health in the case of development a psychic disease associated with the concomitant HIV infection and the accompanying infectious pathology.
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Affiliation(s)
- D S Kadochnikov
- Federal state budgetary institution "Russian Centre of Forensic Medical Expertise", Russian Ministry of Health, Moscow, Russia, 125284; State budgetary educational institution of additional professional education "Russian Medical Academy of Post-Graduate Education", Russian Ministry of Health, Moscow, Russia, 125993
| | - D A Polianskiĭ
- Moscow Research Institute of Psychhiatry affiliated with the federal state budgetary institution V.P. Serbsky Medical Research Centre of Psychiatry and Narcology", Russian Ministry of Health, Moscow, Russia, 107076
| | - P V Minaeva
- Federal state budgetary institution "Russian Centre of Forensic Medical Expertise", Russian Ministry of Health, Moscow, Russia, 125284
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Ivars Lleó M, Clavo Escribano P, Menéndez Prieto B. Atypical Cutaneous Manifestations in Syphilis. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Ivars Lleó M, Clavo Escribano P, Menéndez Prieto B. Atypical Cutaneous Manifestations in Syphilis. ACTAS DERMO-SIFILIOGRAFICAS 2015; 107:275-83. [PMID: 26708562 DOI: 10.1016/j.ad.2015.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 10/26/2015] [Accepted: 11/07/2015] [Indexed: 11/16/2022] Open
Abstract
Although the diversity of the clinical manifestations of syphilis is well-known, atypical presentations can also occur. Such atypical presentations are associated with a high risk of transmission as a result of diagnostic confusion and treatment delays owing to the disease's ability to mimic other common skin diseases, deviate from classic clinical presentations, and adopt unique forms. Cases of atypical syphilis have been described most frequently in patients with concomitant human immunodeficiency virus (HIV) infection. Because the incidence of syphilis has been growing over recent years -particularly in patients with HIV co-infection- dermatologists need to be familiar with the less well-known clinical presentations of this venereal disease.
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Affiliation(s)
- M Ivars Lleó
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, España.
| | - P Clavo Escribano
- Departamento de Dermatología, Centro Sanitario Sandoval, Madrid, España
| | - B Menéndez Prieto
- Departamento de Microbiología, Centro Sanitario Sandoval, Madrid, España
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Ruiz-Sancho A, Barreiro P, Castellares C, Labarga P, Ramos B, Garcia-Samaniego J, Gutiérrez M, Soriano V. Outbreak of Syphilis, but Not of Acute Hepatitis C, Among HIV-Infected Homosexual Men in Madrid. HIV CLINICAL TRIALS 2015; 8:98-101. [PMID: 17507325 DOI: 10.1310/hct0802-98] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Clustered cases of acute hepatitis C virus (HCV) infection, frequently accompanied by sexually transmitted diseases, have recently been reported among men who have sex with men (MSM) in several European cities. METHOD We performed a retrospective record of cases of syphilis in a large cohort of HIV-infected individuals on regular follow-up in Madrid, Spain. HCV testing was carried out in all of them. RESULTS A total of 53 diagnosis of syphilis were made during the previous 4 years (2002 to 2005) in 729 HIV-infected MSM on regular follow-up. However, in only 2 of them (3.7%) asymptomatic HCV seroconversion occurred at the time of the syphilis episode. Both patients developed chronic hepatitis C. CONCLUSION Acute HCV infection should periodically be ruled out in all HIV-infected MSM engaged in sexual risky behaviors presenting with syphilis.
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Haubrich R, Soriano V, Lafeuillade A. Statements from the 15th International Symposium on HIV and Emerging Infectious Diseases (ISHEID), Toulon, France, May 28–30, 2008. HIV CLINICAL TRIALS 2015; 9:348-65. [DOI: 10.1310/hct0905-348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
OBJECTIVE Neurosyphilis is caused by dissemination into the central nervous system of Treponema pallidum. Although the incidence of syphilis in the Netherlands has declined since the mid-1980s, syphilis has re-emerged, mainly in the urban centres. It is not known whether this also holds true for neurosyphilis. METHODS The epidemiology of neurosyphilis in Dutch general hospitals in the period 1999-2010 was studied in a retrospective cohort study. Data from the Dutch sexually transmitted infection (STI) clinics were used to analyse the number of patients diagnosed with syphilis in this period. RESULTS An incidence of neurosyphilis of 0.47 per 100 000 adults was calculated, corresponding with about 60 new cases per year. This incidence was higher in the western (urbanised) part of the Netherlands, as compared with the more rural areas (0.6 and 0.4, respectively). The number of patients diagnosed with syphilis in STI clinics increased from 150 to 700 cases in 2004 and decreased to 500 new cases in 2010. The sex ratio was in favour of men, yielding a percentage of 90% of the syphilis cases and of 75% of the neurosyphilitic cases. The incidence of neurosyphilis was highest in men aged 35-65 years, and in women aged 75 years and above. The most frequently reported clinical manifestation of neurosyphilis was tabes dorsalis. In this study, 15% of the patients were HIV seropositive. CONCLUSION The incidence of neurosyphilis in a mixed urban-rural community such as the Netherlands is comparable to that in other European countries. Most patients are young, urban and men, and given the frequent atypical manifestations of the disease reintroduction of screening for neurosyphilis has to be considered.
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12
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The Spectrum of HIV-Associated Infective and Inflammatory Dermatoses in Pigmented Skin. Dermatol Clin 2014; 32:211-25. [DOI: 10.1016/j.det.2013.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Firlag-Burkacka E, Cielniak I, Swiecki P, Siwak E, Gizinska J, Bakowska E, Kubicka J, Kowalski J, Podlasin R, Horban A. The increasing prevalence of neurosyphilis and high serum VDRL titers in HIV positive patients—Data from outpatient clinic in Warsaw, Poland (POLCA Cohort). HIV & AIDS REVIEW 2013. [DOI: 10.1016/j.hivar.2013.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Ahamed S, Varghese M, El Agib EN, Ganesa VS, Aysha M. Case of neurosyphilis presented as recurrent stroke. Oman Med J 2012; 24:134-6. [PMID: 22334859 DOI: 10.5001/omj.2009.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 02/16/2009] [Indexed: 11/03/2022] Open
Abstract
A 46 year old male patient was presented with a history of hypertension, diabetes mellitus and coronary artery disease was reported to have had a cerebrovascular accident of which features were suggestive of a new and rapidly progressive stroke. Upon investigation for recurrent stroke, the patient was found to have a positive serology for Syphilis. The possibility of neurosyphilis was considered, which was later confirmed by positive serology in the cerebrospinal fluid. The case is lenghly discussed in this report to emphasize the presence of syphilis in the 21st century, and to ascertain its importance as an etiological agent in cases of recurrent stroke.
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Muldoon EG, Mooka B, Reidy D, O'Dea S, Clarke S, Courtney G, Lyons F, Bergin C, Mulcahy F. Long-term neurological follow-up of HIV-positive patients diagnosed with syphilis. Int J STD AIDS 2012; 23:676-8. [DOI: 10.1258/ijsa.2012.012041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
No cerebrospinal fluid (CSF) abnormalities are found in HIV-positive patients in long-term follow-up after standard syphilis treatment. Syphilis has been reported to have immunological effects on HIV infection and HIV is known to modulate both the manifestations of syphilis and the serological response to therapy. HIV-positive patients who had been diagnosed with and treated for syphilis prior to 2007 were identified. Patients were consented for lumbar puncture. Serum HIV viral load, CD4 count and CSF were recorded. Thirty-five patients with previously diagnosed and treated syphilis underwent lumbar puncture. Thirty-four patients had a normal neurological exam. Only one patient had an abnormal mean white cell count (10.7 cells per high-power field). The finding that those with previously diagnosed syphilis had normal CSF and clinical findings is reassuring and supports the practice of using standard syphilis therapy in HIV-positive patients.
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Affiliation(s)
- E G Muldoon
- Department of Genitourinary Medicine and Infectious Diseases, St James's Hospital, Dublin
| | - B Mooka
- Department of Infectious Diseases, Mid-Western Regional Hospital, Limerick, Ireland
| | - D Reidy
- Department of Genitourinary Medicine and Infectious Diseases, St James's Hospital, Dublin
| | - S O'Dea
- Department of Genitourinary Medicine and Infectious Diseases, St James's Hospital, Dublin
| | - S Clarke
- Department of Genitourinary Medicine and Infectious Diseases, St James's Hospital, Dublin
| | - G Courtney
- Department of Genitourinary Medicine and Infectious Diseases, St James's Hospital, Dublin
| | - F Lyons
- Department of Genitourinary Medicine and Infectious Diseases, St James's Hospital, Dublin
| | - C Bergin
- Department of Genitourinary Medicine and Infectious Diseases, St James's Hospital, Dublin
| | - F Mulcahy
- Department of Genitourinary Medicine and Infectious Diseases, St James's Hospital, Dublin
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Motta D, Brianese N, Focà E, Nasta P, Maggiolo F, Fabbiani M, Cologni G, Di Giambenedetto S, Di Pietro M, Ladisa N, Sighinolfi L, Costarelli S, Castelnuovo F, Torti C. Virological effectiveness and CD4+ T-cell increase over early and late courses in HIV infected patients on antiretroviral therapy: focus on HCV and anchor class received. AIDS Res Ther 2012; 9:18. [PMID: 22703595 PMCID: PMC3409064 DOI: 10.1186/1742-6405-9-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 06/15/2012] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to explore the effects of HCV co-infection on virological effectiveness and on CD4+ T-cell recovery in patients with an early and sustained virological response after HAART. Methods We performed a longitudinal analysis of 3,262 patients from the MASTER cohort, who started HAART from 2000 to 2008. Patients were stratified into 6 groups by HCV status and type of anchor class. The early virological outcome was the achievement of HIV RNA <500 copies/ml 4–8 months after HAART initiation. Time to virological response was also evaluated by Kaplan-Meier analysis. The main outcome measure of early immunological response was the achievement of CD4+ T-cell increase by ≥100/mm3 from baseline to month 4–8 in virological responder patients. Late immunological outcome was absolute variation of CD4+ T-cell count with respect to baseline up to month 24. Multivariable analysis (ANCOVA) investigated predictors for this outcome. Results The early virological response was higher in HCV Ab-negative than HCV Ab-positive patients prescribed PI/r (92.2% versus 88%; p = 0.01) or NNRTI (88.5% versus 84.7%; p = 0.06). HCV Ab-positive serostatus was a significant predictor of a delayed virological suppression independently from other variables, including types of anchor class. Reactivity for HCV antibodies was associated with a lower probability of obtaining ≥100/mm3 CD4+ increase within 8 months from HAART initiation in patients treated with PI/r (62.2% among HCV Ab-positive patients versus 70.9% among HCV Ab-negative patients; p = 0.003) and NNRTI (63.7% versus 74.7%; p < 0.001). Regarding late CD4+ increase, positive HCV Ab appeared to impair immune reconstitution in terms of absolute CD4+ T-cell count increase both in patients treated with PI/r (p = 0.013) and in those treated with NNRTI (p = 0.002). This was confirmed at a multivariable analysis up to 12 months of follow-up. Conclusions In this large cohort, HCV Ab reactivity was associated with an inferior virological outcome and an independent association between HCV Ab-positivity and smaller CD4+ increase was evident up to 12 months of follow-up. Although the difference in CD4+ T-cell count was modest, a stricter follow-up and optimization of HAART strategy appear to be important in HIV patients co-infected by HCV. Moreover, our data support anti-HCV treatment leading to HCV eradication as a means to facilitate the achievement of the viro-immunological goals of HAART.
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Agmon-Levin N, Elbirt D, Asher I, Gradestein S, Werner B, Sthoeger Z. Syphilis and HIV co-infection in an Israeli HIV clinic: incidence and outcome. Int J STD AIDS 2010; 21:249-52. [PMID: 20378895 DOI: 10.1258/ijsa.2009.009011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The re-emergence of syphilis among HIV-infected patients has been reported in recent years. We evaluated co-infection among heterosexual immigrants in an Israeli AIDS center. The records of 1060 HIV-infected patients were evaluated for positive syphilis serology between the years 2000 and 2005, and all seropositive patients were further evaluated. We found 150 HIV/syphilis co-infected patients (57% men, 93% of African origin), of who 135 were found to have late latent syphilis. Lumbar puncture (LP) was performed in 51 patients, 16 (31%) had abnormal cerebrospinal fluid (CSF) compatible with neurosyphilis. Abnormal CSF correlated with the absence of previous anti-syphilis treatment, but not with CD4 count, viral load or Venereal Disease Research Laboratory titres. Penicillin was recommended to all patients according to their disease stages and 81 patients completed 12 months post-treatment follow-up. Twenty-one of 81 (26%) treatments were successful, 33 (41%) showed 'serofast reaction' and 27 (33%) failed therapy. In conclusion, a high incidence of syphilis with CSF reactivity suggestive of neurosyphilis was observed in heterosexual Ethiopian HIV-infected patients. Thus, repeated serological screening and CSF evaluation seems to be indicated in these patients. Penicillin therapy resulted in 'serofast reaction' or treatment failure for most patients. More, intensive treatment might be needed for HIV/syphilis in co-infected patients, especially those with severe immune-deficiency and prolonged syphilis infection.
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Affiliation(s)
- N Agmon-Levin
- Neve-Or AIDS Center, Kaplan Medical Center, Rehovot, Israel
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18
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Pietzsch M, Kutschan A, Hager A, Wiegand W. [Bilateral panuveitis with papillary swelling]. Ophthalmologe 2009; 106:740-5. [PMID: 19655150 DOI: 10.1007/s00347-008-1900-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lues (syphilis) is a chronic cyclic infectious disease which can continue for decades if untreated. A simultaneous HIV infection can result in false negative results in serological tests for lues. The occurrence of neurolues has frequently been described in HIV positive patients. In the differential diagnosis an early ocular manifestion of lues should be considered. A 40-year-old homosexual patient presented in our hospital with bilateral pain-free increasing loss of vision. The ophthalmological examination revealed an intermediately expressed panuveitis with streaky opacity of the vitreous body and pronounced bilateral papillary swelling. Following systemic anti-inflammatory therapy with cortisone the situation worsened after initial improvement. The serological investigations revealed both HIV and lues infections. Intravenous therapy with mega units of penicillin led to a slow improvement of clinical symptoms and also vision. In cases of uveitis of unclear origin together with a HIV infection and suspected lues, regular serological testing should be carried out because the occurrence of late complications of lues can be avoided by the diagnosis of lues and adequate treatment.
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Affiliation(s)
- M Pietzsch
- Augenabteilung, Asklepios Klinik Nord/Heidberg, Deutschland.
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Malignant syphilis in an HIV seropositive woman. Int J Gynaecol Obstet 2008; 102:297-8. [PMID: 18457838 DOI: 10.1016/j.ijgo.2008.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 02/29/2008] [Accepted: 03/03/2008] [Indexed: 12/21/2022]
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Kent ME, Romanelli F. Reexamining syphilis: an update on epidemiology, clinical manifestations, and management. Ann Pharmacother 2008; 42:226-36. [PMID: 18212261 DOI: 10.1345/aph.1k086] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the epidemiology, clinical features, diagnosis, and treatment of syphilis. DATA SOURCES Studies and reviews were abstracted from MEDLINE (1950-April 2007) using the search term syphilis. All papers were cross-referenced to identify additional studies and reviews for inclusion. STUDY SELECTION AND DATA EXTRACTION Pertinent original research articles, review articles, and book chapters were evaluated. DATA SYNTHESIS Syphilis is a spirochetal disease that has plagued mankind for centuries. Following a low incidence of syphilis in the US for the last 2 decades, rates are now increasing both in the US and other parts of the world. Once acquired, syphilis can pass through 4 distinct stages of disease: primary syphilis, secondary syphilis, latent syphilis, and tertiary syphilis, with each stage being characterized by different symptoms and levels of infectivity. Diagnosis is made primarily by serologic assays with nontreponemal tests such as the Venereal Disease Research Laboratory and the Rapid Plasma Reagin assay used for screening. Treponemal tests including the Treponema pallidum particle agglutination and the fluorescent treponemal antibody absorption test are then used for confirmation. Recommended treatment regimens are based largely on uncontrolled trials and clinical experience. Penicillin is the treatment of choice, with the preparation and treatment duration varying for different stages. Benzathine penicillin is the treatment of choice for all stages of syphilis except neurosyphilis, for which aqueous crystalline penicillin or procaine penicillin is used due to the central nervous system penetration of these formulations. Coinfection with both syphilis and HIV occurs frequently due to common risk factors. These 2 diseases interact with each other, making both diagnosis and treatment more complicated. CONCLUSIONS Clinicians should be aware of the signs and symptoms of syphilis as well as current guidelines for the management and treatment of this disease.
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Affiliation(s)
- Molly E Kent
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA
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Abstract
In 2001, the incidence of primary and secondary syphilis increased in the United States for the first time in a decade. Increasing rates of early syphilis among men who have sex with men have been reported in many American cities, with similar outbreaks noted in Canada and Europe. In San Francisco, the increase has been particularly sharp and accompanied by an increase in the incidence of neurosyphilis. Early neurosyphilis develops within weeks to years of primary infection and primarily involves the meninges. Syndromes include syphilitic meningitis (often accompanied by cranial neuropathies), meningovascular syphilis (with associated ischemic stroke), or asymptomatic neurosyphilis. Late neurosyphilis occurs years to decades after exposure as cerebral or spinal gummatous disease or the classic parenchymal forms affecting the brain (general paresis or syphilitic encephalitis) or spinal cord and nerve roots (tabes dorsalis). Treponema pallidum, the causative agent, cannot be cultured in vitro, and microscopic techniques are laborious. Thus, diagnosis depends on serologic tests and cerebrospinal fluid (CSF) examination. The suboptimal sensitivity and specificity of these tests complicate diagnosis, particularly among patients coinfected with HIV. CSF examination should be performed to evaluate for neurosyphilis in all patients with positive serum syphilis serology and neurologic, ophthalmic, or tertiary disease, or in those who have failed therapy, and in HIV-infected patients with late latent syphilis or syphilis of unknown duration. Intravenous penicillin G is the recommended treatment for all forms of neurosyphilis and for syphilitic eye disease. An outpatient alternative, if adherence can be assured, is intramuscular benzathine penicillin with oral probenecid. Newer drugs that penetrate CSF, such as ceftriaxone or azithromycin, have not yet been adequately tested for neurosyphilis. Syphilis facilitates transmission of HIV (and vice versa), and thus all patients diagnosed with syphilis should be offered HIV testing.
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