Document 0013
 DOCN  M95A0013
 TI    Syphilis and neurosyphilis in a human immunodeficiency virus type-1
       seropositive population: evidence for frequent serologic relapse after
       therapy.
 DT    9510
 AU    Malone JL; Wallace MR; Hendrick BB; LaRocco A Jr; Tonon E; Brodine SK;
       Bowler WA; Lavin BS; Hawkins RE; Oldfield EC 3rd; Department of Internal
       Medicine (Infectious Diseases Division),; Naval Medical Center, San
       Diego, California, USA.
 SO    Am J Med. 1995 Jul;99(1):55-63. Unique Identifier : AIDSLINE
       MED/95321352
 AB    OBJECTIVE: To describe clinical and treatment aspects of syphilis
       infection among patients seropositive for the human immunodeficiency
       virus (HIV). PATIENTS AND METHODS: Results of serologic tests for
       syphilis, CD4+ T-lymphocyte counts, and clinical response to therapy
       were retrospectively monitored in 100 HIV-infected adults with syphilis
       from a tertiary-care military HIV program. RESULTS: Of the 1,206
       HIV-infected patients, 100 (8.3%) in the cohort had syphilis; 61
       patients were treated for active syphilis. Serologic or clinical relapse
       eventually occurred in 10 of the 56 treated patients (17.9%) with
       follow-up available; 7 of the 10 who relapsed had previously received
       high-dose intravenous or procaine penicillin therapy. Relapse occurred
       more than 12 months after initial therapy in 6 of 10 patients (60%) who
       experienced relapse; 5 patients experienced multiple relapses. The mean
       CD4+ T-lymphocyte count was not predictive of relapse. Patients with
       reactive cerebrospinal fluid (CSF) Venereal Disease Research Laboratory
       (VDRL) test titers (4 of 7 patients [57%]) or the rash of secondary
       syphilis (4 of 14 patients [29%]) were at highest risk of subsequent
       relapse or treatment failure when monitored for an average of 2 years.
       CONCLUSION: Standard penicillin regimens, including high-dose
       intravenous penicillin, transiently lowered serum VDRL titers in nearly
       all cases, but were sometimes inadequate in preventing serologic and
       clinical relapse in patients infected with HIV type-1, especially among
       those with secondary syphilis and reactive CSF VDRL titers. Careful
       long-term follow-up is essential, and repeated courses of therapy may be
       needed for patients infected with HIV type-1 who have syphilis.
 DE    AIDS-Related Opportunistic Infections/CEREBROSPINAL FLUID/*DRUG  THERAPY
       Chi-Square Distribution  Human  Neurosyphilis/DRUG THERAPY
       Penicillins/*THERAPEUTIC USE  Recurrence  Retrospective Studies
       Syphilis/CEREBROSPINAL FLUID/*DRUG THERAPY  Treatment Outcome  CLINICAL
       TRIAL  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).