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June 9, 2008
Syphilis Treatment Response Improves With HIV Therapy
Combination antiretroviral (ARV) therapy significantly improves syphilis treatment response rates in HIV-positive people undergoing their first course of antibiotics, according to the authors of a study to be published in Clinical Infectious Diseases.
HIV can severely weaken the immune system, making it harder for medications to treat other infections and diseases. The impact of HIV-related immune suppression on the response to syphilis treatment, however, isn’t well understood. Current recommendations for the treatment of syphilis are the same for HIV-positive patients as HIV-negative patients, regardless of the health of a patient’s immune system.
Khalil Ghanem, MD, and his colleagues from Johns Hopkins School of Medicine, in Baltimore, set out to determine whether the degree of immune suppression—and the use of ARV treatment—have an impact on responses to syphilis therapy. They examined the medical records of 180 HIV-positive patients diagnosed with syphilis between 1990 and 2006. The majority of the patients were treated with penicillin.
Of the 180 patients, 39 percent experienced a syphilis treatment failure—they either failed to attain a major reduction in their syphilis antibody levels or they had a good initial antibody response that later increased again. Ghanem’s team found that people who had a CD4 count of less than 200 at the time of their syphilis diagnosis were nearly 2.5 times more likely to experience a syphilis treatment failure as people with a CD4 count above 200.
Ghanem’s group also found that combination ARV treatment reduced the risk of syphilis treatment failure by 60 percent. The more the CD4 count recovered after starting ARV treatment, they found, the greater the reduction in syphilis treatment failure risk. Ghanem’s team writes that further research on the interaction between HIV, ARV treatment and syphilis should be conducted, but that “aggressive HIV infection management” could improve syphilis treatment responses in people with HIV.
