TreatmentUpdate 55 - Vol. 7, No. 1 - January 1995
Sean Hosein

Infections normally kept under control may reappear as the immune system begins to break down under constant attack by HIV. A number of researchers have claimed that in patients with HIV/AIDS:

- lab tests for syphilis may not be accurate - standard anti-syphilis therapy may not be effective - chronic infection with T. pallidum (the cause of syphilis) may weaken the immune system

Doctors at a clinic in Baltimore, Maryland, have been studying the interaction between syphilis and HIV. By reviewing records on over 300 patients (both HIV- infected and non-infected) from their clinic they hoped to find information that might be useful when caring for HIV-infected patients who also have syphilis.

* STUDY DETAILS

The doctors looked at data from patients with primary or secondary syphilis or early latent syphilis. Patients who had primary syphilis had:

- an ulcer on their genitals - detectable T. pallidum in samples from those ulcers - a 'positive' FTA-ABS test (reactive fluorescent treponemal antibody absorption test). Researchers used this test because it gave them more accurate results than the RPR (rapid plasma reagin test card) test.

Patients with secondary syphilis had:

- rash - mucous patches - wart-like lesions, and a 'positive' RPR/FTA-ABS test in the past 12 months. Prior to this their test result was 'negative'.

Patients with early syphilis had:

- no symptoms - had a 'positive' RPR/FTA-ABS while in the past 12 months these tests had been 'negative'.

* RESULTS

The researchers found that HIV+ patients (both men and women) were more likely to have secondary syphilis than early syphilis. There was a trend when the researchers looked at CD4+ cell counts. Subjects with less than 500 CD4+ cells were more likely to have secondary syphilis. All four patients with less than 200 CD4+cells had secondary syphilis.

* TREATMENT

Patients received either one injection of benzathine penicillin or 200 mg/day of doxycycline for 2 weeks. Despite this treatment 16 subjects did not recover. Interestingly, fifteen of these patients had received the single injection of benzathine penicillin. Eighteen percent of HIV-infected and 14% of the non-HIV-infected did not respond properly when they received treatment. This difference was not statistically significant.

REFERENCES:

1. Hutchinson CM, Hook EW, Shepard M, et al. Altered clinical presentation of early syphilis in patients with Human Immunodeficiency Virus infection. Annals of Internal Medicine 1994;121 :94-99.

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