Single Dose Versus 3 Doses of Intramuscular Benzathine Penicillin for Early Syphilis in HIV: A Randomized Clinical Trial

Andrade, Roberto; Rodriguez‐Barradas, Maria C.; Yasukawa, Kosuke; Villarreal, Erick; Ross, Michael W.; Serpa, José A.

doi:10.1093/cid/ciw862

Cited by 25 publications

(10 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In other studies [9, 10, 14], which are in agreement with these results, a 1-dose BPG regimen for PLWH showed an efficacy that was similar to that of the 3-dose BPG regimen; it should be considered the firstline regimen in treatment of episodes of early syphilis among PLWH, in accordance with current international guidelines.…”

Section: Discussionsupporting

confidence: 84%

“…A high proportion of clinicians who care for patients with HIV continue to use 3 doses of benzathine penicillin G (BPG) to treat early syphilis [9, 14] because of possible concerns regarding the lower efficacy of the recommended 1-dose BPG regimen. Additionally, limited data [15, 16] are available on the efficacy of the alternative regimen, doxycycline, especially for the treatment of late latent syphilis.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Incidence and Predictors of Serological Treatment Response in Early and Late Syphilis Among People Living With HIV

Spagnuolo

Poli

Galli

et al. 2018

Open Forum Infectious Diseases

View full text Add to dashboard Cite

BackgroundFew studies have investigated predictors of serological response to syphilis treatment in people living with HIV (PLWH).MethodsThis was a retrospective, longitudinal study on PLWH who were diagnosed with and treated for syphilis who had an assessable serological response between January 2004 and June 2016. Serological treatment response (TR) was defined as a ≥4-fold decline in rapid plasma reagin (RPR) titers or a reversion to nonreactive (if RPR ≤1:4 at diagnosis) 12 months after treatment for early syphilis and 24 months after treatment for late syphilis. Factors associated with a TR were assessed with multivariate Cox proportional hazard models for recurrent events.ResultsA total of 829 episodes of syphilis (686 early, 143 late) in 564 patients were recorded. TR was observed in 732 (88%) syphilis episodes. The proportion of TR differed between early and late syphilis (89% vs 83%, respectively; P = .045). For early syphilis, TR was associated with a higher nadir CD4+ cell count (adjusted hazard ratio [AHR], 1.06; P = .029), an RPR titer >1:32 at diagnosis (AHR, 1.26; P = .009), secondary syphilis (AHR, 1.29; P = .008), and cases of syphilis diagnosed in more recent calendar years (AHR, 1.36; P < .0001). In late syphilis, TR was more likely to occur for first infections (AHR, 1.80; P = .027), for episodes that occurred in more recent years (AHR, 1.62; P = .007), and for RPR titers >1:32 at diagnosis (AHR, 2.04; P = .002). TR was not associated with the type of treatment regimen in early and late syphilis.ConclusionsHigher RPR titers at diagnosis and a diagnosis of syphilis that was made in more recent years were associated with TR in early and late syphilis.

show abstract

Section: Discussionsupporting

confidence: 84%

mentioning

confidence: 99%

Incidence and Predictors of Serological Treatment Response in Early and Late Syphilis Among People Living With HIV

Spagnuolo

Poli

Galli

et al. 2018

Open Forum Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…Four‐fold changes in non‐treponemal antibody titres are considered indicative of treatment response when decreasing or active infection/reinfection when increasing. Most of the studies published show no association between serological outcome and antibiotic treatment regimen in HIV‐coinfected patients [8–10,13]. Only the study by Yang et al .…”

Section: Discussionmentioning

confidence: 99%

Predictors of serofast state after treatment for early syphilis in HIV‐infected patients

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

“…Serologic response was defined as a decline of RPR titers by at least fourfold or reversion to non-reactivity compared with baseline RPR titers during the 12-month follow-up period. Treatment failure was defined as lack of at least a fourfold decline in RPR titers or at least a fourfold increase in RPR titers after achieving serologic response during follow-up [8,9]. The primary outcome was serologic response rate at 12 months from BPG treatment [7][8][9].…”

Section: Treatment and Follow-upmentioning

confidence: 99%

“…Treatment failure was defined as lack of at least a fourfold decline in RPR titers or at least a fourfold increase in RPR titers after achieving serologic response during follow-up [8,9]. The primary outcome was serologic response rate at 12 months from BPG treatment [7][8][9]. The secondary outcomes were serologic response rate at 6 months from BPG treatment, rates of treatment failure at 6 and 12 months, and Jarisch-Herxheimer (JH) reaction following BPG injection.…”

Section: Treatment and Follow-upmentioning

confidence: 99%

Comparisons of Serologic Responses of Early Syphilis to Treatment with a Single-Dose Benzathine Penicillin G Between HIV-Positive and HIV-Negative Patients

et al. 2021

View full text Add to dashboard Cite

Introduction Poorer serologic responses of early syphilis to treatment have been inconsistently reported in HIV-positive patients compared with HIV-negative patients, but the interpretation of previous studies is limited by discrepant study designs. The present study aimed to evaluate the effect of HIV infection on the treatment response to a single dose of benzathine penicillin G (BPG) for early syphilis. Methods From January 2015 to March 2020, adult patients with early syphilis who received a single dose of BPG were enrolled and rapid plasma reagin (RPR) titers were periodically determined. The primary outcome was serologic response, defined as at least a fourfold decline of RPR titer at 12 months of BPG treatment compared with that at baseline, which was examined in the intention-to-treat (ITT) and per-protocol analyses. Treatment failure included lack of at least a fourfold decline in RPR titers and at least a fourfold increase in RPR titers. Results We prospectively enrolled 184 HIV-positive and 68 HIV-negative participants with early syphilis, who were all men who have sex with men, with a higher proportion of previous syphilis (70.1%) and early latent syphilis (64.1%) among HIV-positive participants. In the ITT with last-observation-carried-forward analysis, HIV-positive participants had a significantly lower serologic response rate at 12 months of treatment than HIV-negative participants (73.4% vs. 91.2%). Of HIV-positive participants, 12.5% failed to achieve at least fourfold decline in RPR titers and 14.1% had at least a fourfold increase in RPR titers. The factors associated with 12-month serologic response were HIV infection (adjusted odds ratio [AOR] 0.33; 95% confidence interval [CI] 0.13–0.81) and RPR titer (per 1-log 2 increase, AOR 1.36; 95% CI 1.23–1.51). Conclusion HIV-positive patients with early syphilis had poorer serologic responses to BPG treatment than HIV-negative patients during a 12-month follow-up period. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00450-6.

show abstract

Single Dose Versus 3 Doses of Intramuscular Benzathine Penicillin for Early Syphilis in HIV: A Randomized Clinical Trial

Abstract: NCT02611765.

Cited by 25 publications

References 15 publications

Incidence and Predictors of Serological Treatment Response in Early and Late Syphilis Among People Living With HIV

Incidence and Predictors of Serological Treatment Response in Early and Late Syphilis Among People Living With HIV

Predictors of serofast state after treatment for early syphilis in HIV‐infected patients

Comparisons of Serologic Responses of Early Syphilis to Treatment with a Single-Dose Benzathine Penicillin G Between HIV-Positive and HIV-Negative Patients

Contact Info

Product

Resources

About