Effects of HIV Infection on the Serologic Manifestations and Response to Treatment of Syphilis in Intravenous Drug Users
- Marc N. Gourevitch, MD;
- Peter A. Selwyn, MD;
- Katherine Davenny, MPH;
- Donna Buono, MS;
- Ellie E. Schoenbaum, MD;
- Robert S. Klein, MD; and
- Gerald H. Friedland, MD
- From Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York. Requests for Reprints: Marc N. Gourevitch, MD, Department of Epidemiology and Social Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467. Acknowledgments: The authors thank Phil Alcabes, PhD, and Zena Stein, MA, MB, Bch, for comments on the manuscript; Sarah McLaughlin for technical assistance; and Nancy Budner, MPH, Andrea Gachupin-Garcia, and Jane Shaw, MD, for assistance with data collection. Grant Support: By Centers for Disease Control Cooperative Agreement #U64/CCU200714 and by grants from the National Institute of Drug Abuse (#RO1 DA04347-05) and the Aaron Diamond Foundation.
Abstract
Objective: To describe the effects of human immunodeficiency virus (HIV) infection on the serologic manifestations and response to treatment of syphilis in intravenous drug users.
Design: Cohort study of intravenous drug users.
Setting: Medical clinic in a hospital-based methadone maintenance treatment program in New York City.
Patients: Fifty patients with syphilis, of whom 31 were HIV seropositive and 19 HIV seronegative.
Measurements: Serologic tests for syphilis and clinical manifestations.
Results: Stage of syphilis at presentation was not associated with HIV serologic status. No unusual or fulminant manifestations of early syphilis or neuro-syphilis were noted among HIV-seropositive cases. Maximum nontreponemal titers were higher among HIV-seropositive (median, 1:128) than among HIV-seronegative (median, 1:32) patients with syphilis (P = 0.05); this difference was present only among patients with first-episode syphilis. All 26 evaluable, HIV-seropositive patients treated for syphilis responded appropriately, including 13 patients given standard or less-than-standard doses of penicillin. Seven of 43 patients (16%) showed reversion to negative treponemal antibody assay results after treatment for syphilis; this finding was not associated with HIV infection, CD4 count, or stage of syphilis. Low nontreponemal titer was weakly associated with treponemal test reversion.
Conclusions: Infection with HIV did not alter the stage at presentation, clinical course, serologic manifestations, or response to treatment of syphilis in this cohort of intravenous drug users.
- Copyright ©2004 by the American College of Physicians
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