Effect of Early Syphilis Infection on Plasma Viral Load and CD4 Cell Count in Human Immunodeficiency Virus–Infected Men

Jarzebowski, Witold

doi:10.1001/archinternmed.2012.2706

Cited by 96 publications

(89 citation statements)

References 30 publications

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“…These findings are concordant with other reports. 6,27,28 Patients in this study had a slight and transient increase in VL. However, there was a significant difference in the proportion of VL increase among patients under ART compared with those not receiving ART.…”

Section: Discussionmentioning

confidence: 59%

Early syphilis affects markers of HIV infection

et al. 2016

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The objective of this study was to investigate if early syphilis infection affects markers of HIV infection; CD4 T cells and viral load (VL). A retrospective study was performed on 160 HIV-positive patients (111 receiving antiretroviral therapy [ART] and 49 without ART). Early syphilis diagnosis was made in HIV patients during their follow-up at the HIV/AIDS Unit at a Greek Dermatology and Venereology Unit. The patients' blood tests were available at the time of diagnosis, as well as before and 12 weeks after early syphilis diagnosis. CD4 T cell counts and VL levels were measured. It was found that syphilis infection had a negative impact on the CD4 T cell counts in both groups, with reduced CD4 T cell counts observed in 84.6% (99/111) and 79.5% (39/49) of patients receiving and not receiving ART, respectively. After treatment for syphilis, CD4 T cell counts returned to pre-treatment levels in most patients, especially those receiving ART. There was a slight and transient VL increase. Patients receiving ART had a 27% increase in VL, compared to 71.4% among patients not receiving ART. Although the VL increase was slight (41-14,000 copies/ml) in the group under treatment, 4-5% (5/111) patients did not return to pre-treatment levels. Moreover, viral mutations associated with treatment resistance were identified in these patients. Early syphilis accelerates and complicates the progression of HIV infection. Early diagnosis and treatment of syphilis may prevent infection-associated complications in most instances. Consequently, prevention of syphilis and other sexually transmitted infections is of great importance for patients infected with HIV.

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Section: Discussionmentioning

confidence: 59%

Early syphilis affects markers of HIV infection

et al. 2016

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“…Risk for increased transmission of HIV is evidenced by a transient but significant increase in plasma viral load in HIV-infected individuals who have primary and secondary syphilis, even among those whose HIV viral loads had previously been controlled. 6-7 On the other hand, HIV acquisition is increased two to nine fold when syphilis is already present. 8 It remains unclear whether there is an increased biological susceptibility to HIV infection when HIV is transmitted at the same time as syphilis.…”

Section: Introductionmentioning

confidence: 99%

Doxycycline Prophylaxis to Reduce Incident Syphilis among HIV-Infected Men Who Have Sex With Men Who Continue to Engage in High-Risk Sex

Bolan

Beymer

Weiss³

et al. 2015

Sexually Transmitted Diseases

158

124

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Background Incident syphilis infections continue to be especially prevalent among a core group of HIV-infected men who have sex with men (MSM). Because of synergy between syphilis and HIV infections, innovative means for controlling incident syphilis infections are needed. Methods Thirty MSM who had syphilis twice or more since their HIV diagnosis were randomized to receive either daily doxycycline prophylaxis or contingency management (CM) with incentive payments for remaining free of sexually transmitted diseases (STDs). Subjects were tested for the bacterial STDs gonorrhea (NG), chlamydia (CT) and syphilis at Weeks 12, 24, 36 and 48 and completed a behavioral risk questionnaire during each visit to assess number of partners, condom use and drug use since the last visit. Generalized linear mixed models were used to analyze differences between arms in STD incidence and risk behaviors at follow-up. Results Doxycycline arm subjects were significantly less likely to test positive for any selected bacterial STD during 48 weeks of follow-up (OR: 0.27; CI: 0.09-0.83) compared to CM arm subjects (p = 0.02).There were no significant self-reported risk behavior differences between the Doxycycline and CM arms at follow-up. Conclusions Daily doxycycline taken prophylactically was associated with a decreased incidence of NG, CT, or syphilis incident infections among a core group of HIV-infected MSM at high risk for these infections. Safe and effective biomedical tools should be included in the efforts to control transmission of syphilis, especially in this population. A randomized clinical trial should be conducted to confirm and extend these findings.

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“…The association of syphilis and HIV may be causal, as syphilis can facilitate HIV acquisition [2–8] via mucosal disruption, ulceration [9], or inflammation [10] and HIV transmission by increasing HIV RNA in blood and genital secretions [11]. Alternatively, the association could be due to increased sexual risk behaviors or participation in networks with high prevalence of HIV.…”

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confidence: 99%