REPLY
Effect of HIV Infection on Response to Syphilis
Marc N. Gourevitch;
Ellie E. Schoenbaum; and
Robert S. Klein
1 October 1993 | Volume 119 Issue 7 Part 1 | Pages 635-636
IN RESPONSE:
Our data on HIV-seropositive and -seronegative intravenous drug users' responses to treatment of syphilis failed to show that HIV infection was associated with a higher rate of treatment failure [1]. This observation contrasts with case reports and series suggesting a higher incidence of failure and of rapid progression of syphilis in co-infected persons [2, 3]. Our statement that "no significant difference was seen in clinical or serologic response to standard penicillin treatment by HIV serologic status" is fully supported by our data. Three weekly injections of 2.4 million units of benzathine penicillin is standard treatment for late latent syphilis, and patients with late latent disease who were so treated were included in our analysis. Sample size did not permit us to stratify response-to-treatment data by stage of syphilis. Drs. El-Sadr and Flam are correct that our data do not show the effectiveness of standard treatment of early syphilis in HIV-infected patients.
Our study, which was of limited sample size, concluded that HIV infection does not clearly lead to an excess of syphilis treatment failures when examined in a population-based manner. We agree, and so stated in our paper, that controlled trials are needed to determine how much penicillin is necessary to treat syphilis in HIV-infected patients.
1. Gourevitch MN, Selwyn PA, Davenny K, Buono D, Schoenbaum EE, Klein RS, et al. Effects of HIV infection on the serologic manifestations and response to treatment of syphilis in intravenous drug users. Ann Intern Med. 1993; 118:350-5.
2. Lukehart SA, Hook EW, Baker-Zander SA, Collier AC, Critchlow CW, Handsfield HH. Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment. Ann Intern Med. 1988; 109:855-62.
3. Berry CD, Hooton TM, Collier AC, Lukehart SA. Neurologic relapse after benzathine penicillin therapy for secondary syphilis in a patient with HIV infection. N Engl J Med. 1987; 316:1587-9.
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