CONHIV14 - HIV-related Infections, Co-infections and Cancers, etc. – Part three - page 5

Retrospective, longitudinal study on HIV-infected subjects followed at Infectious Diseases Department-OSR, diagnosed and treated for syphilis and with an assessable serological
response between 1 January 2004 and 15 September 2013.
Lack of Serological Response (LSR):
a <4-fold decline of RPR titer or a failed reversion to nonreactive (if RPR ≤1:4 at diagnosis) after 1 year since treatment.
Syphilis staged as
early syphilis
(primary, secondary and early latent) or
late syphilis
(tertiary and late latent) according to clinical examination and patient’s history.
First infections:
positive RPR and TPHA titers in subjects without previous history of syphilis;
Re-infections
: a ≥4-fold increase of RPR titer in subjects previously successfully treated for
syphilis. Syphilis treatment was prescribed according to CDC guidelines.
Results were described as median (IQR) or frequency (%). Continuous and categorical variables were compared by the non-parametric Mann-Whitney rank-sum test and the Chi-Square
or Fisher’s exact test respectively. The crude incidence rates of LSR were expressed per 1000-person months of follow-up (PMFU) and calculated as the total number of episodes divided
by cumulative follow-up contributed by all subjects. Incidence rates were assessed using Poisson regression models.
The cumulative follow-up was calculated as the sum of all intervals time since each syphilis diagnosis and the date of ascertainment of response.
The risk of LSR was estimated by univariate and multivariate (including covariates with p<0.20 at univariate analysis) Cox proportional hazard models for recurrent events
5
.
V. Spagnuolo
1,2
, A. Poli
1,2
, L. Galli
1
, M. Cernuschi
1
, S. Nozza
1
, M. Maillard
1
, N. Gianotti
1
, H. Hasson
1
, S. Bossolasco
1
, A. Lazzarin
1,2
, A. Castagna
1
1 Department of Infectious Diseases, IRCCS San Raffaele, Milan, Italy
2. Università Vita-Salute San Raffaele, Milan, Italy
Background
Methods
Results
Conclusions
During the 2004-2013 period we observed a 12% of lack of serological response to syphilis treatment and incidence of LSR decreased over time.
Lack of serological response was associated with older age, late syphilis stage, lower nadir CD4+ and a detectable HIV viremia.
Subjects with risk factors for LSR should be carefully monitored (both clinically and serologically) after treatment, in order to identify promptly those who need CSF examination and re-
treatment
.
Predictors of Lack of Serological Response to Syphilis Treatment in
HIV-infected Subjects
In the Western countries a resurgence of syphilis has been noted after 2000
1
.
In some studies HIV-infected subjects with syphilis showed a higher proportion of serologically defined treatment failure compared to HIV-uninfected
2,3
.
Few data
4
are available on predictors of lack of serological response to syphilis treatment in HIV-infected subjects
The aim of this study was to determine factors associated with the risk of lack of serological response to treatment of syphilis among HIV-infected subjects.
References
Acknowledgments
We are thankful to all patients who partecipated to the study.
A special thank to the colleagues and nurses from Infectious Diseases
Department of San Raffaele Scientific Institute
565 diagnoses of syphilis with an assessable serological response in 421 patients; 458 (81%) were early syphilis, 189 (33%) were first infections, 376 (67%) were re-infections. Patients’
distribution is reported in
Figure 1
.
At first diagnosis of syphilis median age was 41 (36-47) years, 419 (99.5%) males, 391 (93%) MSM, HIV-infected since 7.7 (3.5-12.9) years, 75 (18%) HCV or HBV co-infected, 56 (13%) with
a previous AIDS diagnosis, 82 (19%) antiretroviral treatment naive, 102 (24%) with HIV-RNA ≥50 cp/ml, CD4+= 576 (437-749) cells/mm3, nadir CD4+= 308 (194-406) cells/mm3. Patients’
characteristics according to syphilis treatment response in
Table 1
.
Over 3497 PMFU, 70 LSRs were observed among 565 treated syphilis for an overall incidence rate of 20.0 (15.3-24.7) per 1000 PMFU. Incidence of LSR decreased over time as shown in
Figure 2
. Results of univariate and multivariate analysis on the risk of LSR are reported in
Table 2
.
Figure 1. Patients’ distribution
Table 1. Patients’ and syphilis characteristics according to syphilis treatment response
Figure 2. Incidence of lack of serological response (LSR) over time
Among
421
subjects included in the analysis:
305 (72%)
subjects had
a single diagnosis
of syphilis,
93 (22%)
had
2 diagnoses
,
19 (5%)
had
3 diagnoses
,
3 (0.8%)
had
4 diagnoses
and
1 (0.2%)
subject had
5 diagnoses
of syphilis between January 2004 and September
2013
.
Table 2. Univariate and multivariate Cox proportional hazard model for recurrent events on the
risk of lack of serological response to treatment of syphilis
.
1 Sexually transmitted disease surveillance 2009, available at:
.
2 Rolfs RT et al. A randomized trial of enhanced therapy for early syphilis in patients
with and without human immunodeficiency virus infection. The syphilis and HIV study grou. NEJM 1997; 337-307-14; 3 Manavi K et al. The outcome of treatment of early latent syphilis and
syphilis with undetermined duration in HIV-infected and HIV-uninfected patients. Int J STD AIDS 2007; 18: 814-8. 4 Khalil G et al. Antiretroviral therapy is associated with reduced serologic
failure rates for syphilis among HIV-infected subjects CID 2008; 47:258-65. 5 Hosmer W, Lemeshow S. Applied survival analysis. Wiley-interscience 1998; 9.2-308-317
Poster P122
1,2,3,4 6,7,8,9,10,11,12
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