Paul, G., Wesselmann, J., Adzic, D., Malin, J. J., Suarez, I, Priesner, V, Kummerle, T., Wyen, C., Jung, N., van Bremen, K., Schlabe, S., Wasmuth, J-C, Boesecke, C., Fatkenheuer, G., Rockstroh, J., Schwarze-Zander, C. and Lehmann, C. . Predictors of serofast state after treatment for early syphilis in HIV-infected patients. HIV Med.. HOBOKEN: WILEY. ISSN 1468-1293

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Abstract

Objectives Non-treponemal serological tests are used to monitor treatment response during syphilis infection. Syphilis- and HIV-coinfected patients may experience incomplete resolution in non-treponemal titres, which is referred to as the serofast state. The goal of this study was to evaluate risk factors for serofast state in HIV-infected patients. Methods From November 2015 to June 2018, 1530 HIV-positive patients were tested for syphilis using a Treponema pallidum particle agglutination (TPPA) assay. Among TPPA-positive patients, medical records were reviewed for early syphilis infection. Serofast state was defined as a less than four-fold decrease in non-treponemal antibody titres during a 6-month follow-up period in the absence of symptoms of syphilis. Baseline characteristics were tested as predictive factors of serological response. Results In all, 515 patients (33.7%) tested positive in TPPA assays, and in 163 patients at least one previous syphilis infection was documented. A total of 61 out of 163 patients (37.4%) were in a serofast state. A history of previous syphilis infection (61 vs. 43%; P = 0.04) was more common in serofast patients than in patients with serological cure after 6 months. Non-treponemal titres >= 1:32 before therapy (47 vs. 25%; P = 0.005) and adjunctive corticosteroids to prevent the Jarisch-Herxheimer reaction (35% vs 15%; P = 0.006) were associated with serological cure after 6 months, but corticosteroid therapy had no influence at 12 months. The intensity of syphilis treatment did not affect serological cure. Conclusion Corticosteroids for prevention of the Jarisch-Herxheimer reaction were associated with earlier serological cure. Although serological response is the accredited surrogate method to monitor syphilis treatment, the biological significance of the serofast state remains unclear.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Paul, G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wesselmann, J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Adzic, D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Malin, J. J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Suarez, IUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Priesner, VUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kummerle, T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wyen, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jung, N.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van Bremen, K.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schlabe, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wasmuth, J-CUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boesecke, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fatkenheuer, G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rockstroh, J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwarze-Zander, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lehmann, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-314011
DOI: 10.1111/hiv.12985
Journal or Publication Title: HIV Med.
Publisher: WILEY
Place of Publication: HOBOKEN
ISSN: 1468-1293
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
JARISCH-HERXHEIMER REACTION; SEROLOGICAL RESPONSE; ENHANCED THERAPY; MANAGEMENT; RATESMultiple languages
Infectious DiseasesMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/31401

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