İnsan immün yetmezlik virüsü ile enfekte hastalarda sifiliz ko-enfeksiyonunun değerlendirilmesi ve rapid plasma reagin (RRP) titresinin sifiliz evresine göre takibi
Abstract
Amaç: HIV hastalarındaki sifiliz koenfeksiyonu gecikmiş serolojik yanıt ile ilişkilidir. Bu çalışmanın amacı, HIV/sifiliz koenfeksiyonunun sıklığı, tedavi sonrası rapid plasma reagin (RPR) titresinin izlenmesi ve serolojik yanıtı etkileyen faktörler hakkında güncel veriler elde etmektir.
Yöntemler: Ocak 2015-Mart 2023 tarihleri arasında takip edilmiş HIV hastalarının sifiliz enfeksiyonuna yönelik serolojik testleri retrospektif olarak değerlendirildi. Demografik veriler (yaş, cinsiyet), HIV RNA seviyesi, RPR, Treponema pallidum hemaglütinasyon testi (TPHA) ve sifiliz evresi hastane elektronik veri tabanından elde edildi. Serolojik yanıt, Hastalık Kontrol ve Önleme Merkezi (CDC) kriterlerine göre tanımlandı.
Bulgular: Hastaların %36,2'sinde (103/284) frengi koenfeksiyonu saptandı ve hastaların tamamı erkekti. Sifiliz evresine göre dağılım sırasıyla primer %2,9, sekonder %9,7, latent %80,6 ve nörosifiliz %6,8 şeklinde idi. Primer, sekonder ve nörosifilisi olan tüm hastalarda tedaviden sonraki 12 ay içinde RPR titresinde ≥4 kat azalma olurken, latent sifilizli iki hastada 12-24 ay içinde titrede azalma olmadı. Buna göre genel serolojik yanıt %95.8 idi. RPR titresindeki 4 kat azalmanın elde edildiği süre, sifiliz evreleri açısından karşılaştırıldığında, istatistiksel olarak anlamlı bir fark yoktu. Başlangıç RPR titresi >1: 32 olan hastalar, başlangıç RPR titresi ≤1: 32 olanlara göre daha hızlı serolojik yanıt elde etti.
Sonuç: HIV/sifiliz koenfeksiyon oranının oldukça yüksek olduğu gözlemlendi. Hastaların çoğunda CDC'nin tanımladığı zaman aralığında serolojik yanıt alınması umut vericidir. Başlangıç RPR titresi ≤32 olan hastalarda tedavi yanıtının daha uzun sürebileceği göz önünde bulundurulmalıdır. Bunun yanısıra, HIV/sifiliz ko-enfekte hastalarda serolojik yanıtla ilişkili faktörleri araştıran daha ileri prospektif çalışmalara ihtiyaç vardır.
Keywords
Supporting Institution
yok
Project Number
yok
Thanks
yok
References
- Ren M, Dashwood T, Walmsley S. The intersection of HIV and syphilis: Update on the key considerations in testing and management. Curr HIV/AIDS Rep. 2021;18:280-88.
- Marchese V, Tiecco G, Storti S, et al. Syphilis ınfections, reinfections and serological response in a large Italian sexually transmitted disease centre: a monocentric retrospective study. J Clin Med. 2022;11:7499.
- Öztürk S. Syphilis co-infection in individuals living with HIV: Data from tertiary hospitals. Klimik Derg. 2023;36:70-4.
- Erdinc FS, Dokuzoguz B, Unal S, et al. Multicentric HIV study group. Temporal trends in the epidemiology of HIV in Turkey. Curr HIV Res. 2020;18:258-66.
- Sayan M. Turkey’s HIV dynamics and the patient universe. HIV epidemiological status and prevention strategies in Turkey: KLIMIK HIV Study Group Meeting 2017 Oct 14; Istanbul, Turkey. Access date: 16 February 2023. Available from: https://www.klimik.org.tr.
- T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü HIV/AIDS İstatistik. Access date: 20 April 2023. Available from https://hsgm.saglik.gov.tr/tr/bulasici-hastaliklar/hivaids/hiv-aids-liste/hiv-aids-istatislik.html.
- Köksal MO, Beka H, Evlice O, et al. Syphilis seroprevalence among HIV-infected males in Istanbul, Turkey. Rev Argent Microbiol. 2020;52:266-71.
- Sarigül F, Sayan M, İnan D, et al. Current status of HIV/AIDS-syphilis co-infections: a retrospective multicentre study. Cent Eur J Public Health. 2019;27:223-28.
- Sarıgül F, Üser Ü, Öztoprak N. HIV/AIDS Hastalarında sifilis koinfeksiyonu seroprevalansı ve risk faktörleri. Klimik Derg. 2019;32:161-4.
- Aydin O, Cag Y, Ergen P, Yilmaz Karadag F, Ankarali H. Seroprevalence and risk factors of syphilis coinfection in people living with HIV. EJMI. 2022;6:346–51.
- Lemmet T, Cotte L, Allavena C, Huleux T, Duvivier C, Laroche H, et al. High syphilis prevalence and incidence in people living with HIV and preexposure prophylaxis users: A retrospective review in the French Dat’AIDS cohort. PLoS One. 2022;17(5):e0268670.
- Nieuwenburg SA, Sprenger RJ, Schim van der Loeff MF, de Vries HJC. Clinical outcomes of syphilis in HIV-negative and HIV-positive MSM: occurrence of repeat syphilis episodes and non-treponemal serology responses. Sex Transm Infect. 2022;98:95-100.
- Richardson D, Fitzpatrick C, Devlin J, Buss Z, Parkes L, Williams D. Primary syphilis lesion characteristics, serological response and management in HIV-positive and HIV-negative men who have sex with men. Int J STD AIDS. 2020;31:1359-63.
- Ong SY, Tang MM, Dalawi I, et al. Human immunodeficiency virus-infected men who have sex with men with syphilis: A 5-year multicentre study in Malaysia. Med J Malaysia. 2020;75:349-55.
- Spagnuolo V, Poli A, Galli L, Nozza S, Bossolasco S, Cernuschi M, et al. Incidence and predictors of serological treatment response in early and late syphilis among people living with HIV. Open Forum Infect Dis. 2018;6(1):ofy324.
- Lin KY, Yang CJ, Sun HY, et al. Comparisons of serologic responses of early syphilis to treatment with a single-dose Benzathine Penicillin G between HIV-positive and HIV-negative patients. Infect Dis Ther. 2021;10:1287-98.
- Adawaye C, Souleymane AO, Fouda AA, et al. Syphilis diagnosis and serological response to Benzathine Penicillin G among patients attending HIV clinics in N’Djaména, Chad. Int J Infect Dis. 2021;108:461-4.
- Atsawawaranunt K, Kittiyaowamarn R, Phonrat B, Kamolratanakul S, Kangvalpornroj T, Dhitavat J. Time to serological cure and associated factors among syphilis patients with and without HIV in a sexually transmitted infections center, Thailand. Sex Transm Dis. 2020;47:283-9.
- Korkusuz R, Şenoğlu S. Syphilis seroprevalence and associated risk factors in HIV-infected individuals. Mediterr J Infect Microb Antimicrob. 2020;9:13.
- Dinç HÖ, Alkan S, Özbey D, et al. Evaluation of syphilis coinfection in HIV-infected individuals. Klimik Derg. 2020;33:292-6.
- Adaleti R, Kansak N, Aslan M, et al. Comparison of syphilis seropositivity between non- immigrant and immigrant populations in the Anatolian side of Istanbul, Turkiye: Results of five-years retrospective study. North Clin Istanb. 2022;9:590–4.
- Workowski KA, Bolan GA. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015; 64:1–137.
- Abara WE, Hess KL, Neblett Fanfair R, Bernstein KT, Paz-Bailey G. Syphilis trends among men who have sex with men in the United States and Western Europe: A systematic review of trend studies published between 2004 and 2015. PLoS One. 2016;11(7):e0159309.
- Mata-Marín JA, Sandoval-Sánchez JJ, Huerta-García G, et al. Prevalence of antibodies against Treponema pallidum among HIV-positive patients in a tertiary care hospital in Mexico. Int J STD AIDS. 2015;26:81-5.
- CDC. Syphilis Surveillance Supplemental Slides, 2016-2020. Accession date: 23 March 2023. https://www.cdc.gov/std/statistics/syphilis-supplement/default.htm.
- Ren M, Szadkowski L, Walmsley SL. Deciphering the serological response to syphilis treatment in men living with HIV. AIDS. 2020;34:2089-96.
- Dionne-Odom J, Karita E, Kilembe W, et al. Syphilis treatment response among HIV-discordant couples in Zambia and Rwanda. Clin Infect Dis. 2013;56:1829–37.
Evaluation of syphilis co-infection and monitoring of rapid plasma reagin (RRP) titer according to syphilis-stage in human immunodeficiency virus-infected patients
Abstract
Aim: Syphilis co-infection in HIV-infected patients is associated by a delayed serological response. The aim of this study is to obtain current data on the frequency of HIV/syphilis co-infection, the monitoring of rapid plasma reagin (RPR) titer after treatment, and factors affecting the serologic response.
Methods: Serological tests for syphilis of HIV patients followed between January 2015 and March 2023 were evaluated retrospectively. Demografic data (age, sex), level of HIV RNA, RPR, Treponema pallidum haemagglutination test (TPHA), and syphilis stage were obtained from hospital electronic database. Serological response was defined according to Centers for Disease Control and Prevention (CDC) criteria.
Results: Syphilis co-infection was detected in 36.2% of the patients, all of them were male. Distribution of syphilis stage was primary 2.9%, secondary 9.7%, latent 80.6%, and neurosyphilis 6.8%, respectively. All patients with primary, secondary, and neurosyphilis had ≥4-fold decrease in RPR titer within 12 months after treatment, while two patients with latent syphilis didn’t have a decrease in titer within 12-24 months. Overall serologic response was 95.8%. Comparing the time to a 4-fold decrease in the RPR titer in terms of syphilis stage, there was no statistically significant difference. Patients with initial RPR titer >1: 32 achieved faster serologic response than those with initial RPR titer ≤1: 32.
Conclusion: HIV/syphilis coinfection rate was notably high. It is promising that most patients had a serologic response within the time-frame defined by the CDC. It should be considered that treatment response may take longer in patients with an initial RPR titer ≤32. Further prospective studies are needed to understand the factors associated with serologic response in HIV/syphilis co-infected patients.
Project Number
yok
References
- Ren M, Dashwood T, Walmsley S. The intersection of HIV and syphilis: Update on the key considerations in testing and management. Curr HIV/AIDS Rep. 2021;18:280-88.
- Marchese V, Tiecco G, Storti S, et al. Syphilis ınfections, reinfections and serological response in a large Italian sexually transmitted disease centre: a monocentric retrospective study. J Clin Med. 2022;11:7499.
- Öztürk S. Syphilis co-infection in individuals living with HIV: Data from tertiary hospitals. Klimik Derg. 2023;36:70-4.
- Erdinc FS, Dokuzoguz B, Unal S, et al. Multicentric HIV study group. Temporal trends in the epidemiology of HIV in Turkey. Curr HIV Res. 2020;18:258-66.
- Sayan M. Turkey’s HIV dynamics and the patient universe. HIV epidemiological status and prevention strategies in Turkey: KLIMIK HIV Study Group Meeting 2017 Oct 14; Istanbul, Turkey. Access date: 16 February 2023. Available from: https://www.klimik.org.tr.
- T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü HIV/AIDS İstatistik. Access date: 20 April 2023. Available from https://hsgm.saglik.gov.tr/tr/bulasici-hastaliklar/hivaids/hiv-aids-liste/hiv-aids-istatislik.html.
- Köksal MO, Beka H, Evlice O, et al. Syphilis seroprevalence among HIV-infected males in Istanbul, Turkey. Rev Argent Microbiol. 2020;52:266-71.
- Sarigül F, Sayan M, İnan D, et al. Current status of HIV/AIDS-syphilis co-infections: a retrospective multicentre study. Cent Eur J Public Health. 2019;27:223-28.
- Sarıgül F, Üser Ü, Öztoprak N. HIV/AIDS Hastalarında sifilis koinfeksiyonu seroprevalansı ve risk faktörleri. Klimik Derg. 2019;32:161-4.
- Aydin O, Cag Y, Ergen P, Yilmaz Karadag F, Ankarali H. Seroprevalence and risk factors of syphilis coinfection in people living with HIV. EJMI. 2022;6:346–51.
- Lemmet T, Cotte L, Allavena C, Huleux T, Duvivier C, Laroche H, et al. High syphilis prevalence and incidence in people living with HIV and preexposure prophylaxis users: A retrospective review in the French Dat’AIDS cohort. PLoS One. 2022;17(5):e0268670.
- Nieuwenburg SA, Sprenger RJ, Schim van der Loeff MF, de Vries HJC. Clinical outcomes of syphilis in HIV-negative and HIV-positive MSM: occurrence of repeat syphilis episodes and non-treponemal serology responses. Sex Transm Infect. 2022;98:95-100.
- Richardson D, Fitzpatrick C, Devlin J, Buss Z, Parkes L, Williams D. Primary syphilis lesion characteristics, serological response and management in HIV-positive and HIV-negative men who have sex with men. Int J STD AIDS. 2020;31:1359-63.
- Ong SY, Tang MM, Dalawi I, et al. Human immunodeficiency virus-infected men who have sex with men with syphilis: A 5-year multicentre study in Malaysia. Med J Malaysia. 2020;75:349-55.
- Spagnuolo V, Poli A, Galli L, Nozza S, Bossolasco S, Cernuschi M, et al. Incidence and predictors of serological treatment response in early and late syphilis among people living with HIV. Open Forum Infect Dis. 2018;6(1):ofy324.
- Lin KY, Yang CJ, Sun HY, et al. Comparisons of serologic responses of early syphilis to treatment with a single-dose Benzathine Penicillin G between HIV-positive and HIV-negative patients. Infect Dis Ther. 2021;10:1287-98.
- Adawaye C, Souleymane AO, Fouda AA, et al. Syphilis diagnosis and serological response to Benzathine Penicillin G among patients attending HIV clinics in N’Djaména, Chad. Int J Infect Dis. 2021;108:461-4.
- Atsawawaranunt K, Kittiyaowamarn R, Phonrat B, Kamolratanakul S, Kangvalpornroj T, Dhitavat J. Time to serological cure and associated factors among syphilis patients with and without HIV in a sexually transmitted infections center, Thailand. Sex Transm Dis. 2020;47:283-9.
- Korkusuz R, Şenoğlu S. Syphilis seroprevalence and associated risk factors in HIV-infected individuals. Mediterr J Infect Microb Antimicrob. 2020;9:13.
- Dinç HÖ, Alkan S, Özbey D, et al. Evaluation of syphilis coinfection in HIV-infected individuals. Klimik Derg. 2020;33:292-6.
- Adaleti R, Kansak N, Aslan M, et al. Comparison of syphilis seropositivity between non- immigrant and immigrant populations in the Anatolian side of Istanbul, Turkiye: Results of five-years retrospective study. North Clin Istanb. 2022;9:590–4.
- Workowski KA, Bolan GA. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015; 64:1–137.
- Abara WE, Hess KL, Neblett Fanfair R, Bernstein KT, Paz-Bailey G. Syphilis trends among men who have sex with men in the United States and Western Europe: A systematic review of trend studies published between 2004 and 2015. PLoS One. 2016;11(7):e0159309.
- Mata-Marín JA, Sandoval-Sánchez JJ, Huerta-García G, et al. Prevalence of antibodies against Treponema pallidum among HIV-positive patients in a tertiary care hospital in Mexico. Int J STD AIDS. 2015;26:81-5.
- CDC. Syphilis Surveillance Supplemental Slides, 2016-2020. Accession date: 23 March 2023. https://www.cdc.gov/std/statistics/syphilis-supplement/default.htm.
- Ren M, Szadkowski L, Walmsley SL. Deciphering the serological response to syphilis treatment in men living with HIV. AIDS. 2020;34:2089-96.
- Dionne-Odom J, Karita E, Kilembe W, et al. Syphilis treatment response among HIV-discordant couples in Zambia and Rwanda. Clin Infect Dis. 2013;56:1829–37.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Services and Systems (Other) |
| Journal Section | ORIGINAL ARTICLE |
| Authors | |
| Project Number | yok |
| Publication Date | September 28, 2023 |
| Acceptance Date | September 7, 2023 |
| Published in Issue | Year 2023 Volume: 28 Issue: 3 |
This Journal licensed under a CC BY-NC (Creative Commons Attribution-NonCommercial 4.0) International License.