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

Marc N. Gourevitch, MD; Peter A. Selwyn, MD; Katherine Davenny, MPH; Donna Buono, MS; Ellie E. Schoenbaum, MD; Robert S. Klein, MD; and Gerald H. Friedland, MD
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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.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1993;118(5):350-355. doi:10.7326/0003-4819-118-5-199303010-00005
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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.


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Figure 1.
Distribution of maximum nontreponemal titers by human immunodeficiency virus (HIV) serologic status.P

No sera titrated beyond a 1:256 dilution. = 0.05 for difference between maximum nontreponemal titers by HIV serologic status by Wilcoxon test.

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