Effects of HIV Infection on the Serologic Manifestations and Response to Treatment of Syphilis in Intravenous Drug Users

doi:10.1059/0003-4819-118-5-199303010-00005

Effects of HIV Infection on the Serologic Manifestations and Response to Treatment of Syphilis in Intravenous Drug Users

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.