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Effect of HIV Infection on Response to Syphilis
- Marc N. Gourevitch, MD;
- Ellie E. Schoenbaum, MD; and
- Robert S. Klein, MD
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Type with double-spacing
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IN RESPONSE:
Our data on HIV-seropositive and -seronegative intravenous drug users' responses to treatment of syphilis failed to show that HIV infection was associated with a higher rate of treatment failure [1]. This observation contrasts with case reports and series suggesting a higher incidence of failure and of rapid progression of syphilis in co-infected persons [2, 3]. Our statement that no significant difference was seen in clinical or serologic response to standard penicillin treatment by HIV serologic status is fully supported by our data. Three weekly injections of 2.4 million units of benzathine penicillin is standard treatment for late latent syphilis, and patients with late latent disease who were so treated were included in our analysis. Sample size did not permit us to stratify response-to-treatment data by stage of syphilis. Drs. El-Sadr and Flam are correct that our data do not show the effectiveness of standard treatment of early syphilis in HIV-infected patients.
Our study, which was of limited sample size, concluded that HIV infection does not clearly lead to an excess of syphilis treatment failures when examined in a population-based manner. We agree, and so stated in our paper, that controlled trials are needed to determine how much penicillin is necessary to treat syphilis in HIV-infected patients.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
