Antiretroviral therapy is associated with reduced serologic failure rates for syphilis among HIV-infected patients.
Open accessAbstract
BACKGROUND: Syphilis and human immunodeficiency virus (HIV) frequently coexist in patients, but the effects of immunosuppression on the course of syphilis are unknown. Our goal was to determine whether the degree of HIV-mediated immunosuppression and the use of highly active antiretroviral therapy impact syphilis serologic responses. METHODS: We assessed all cases of syphilis with positive serologic test results from 1990 through 2006 in a prospective, observational clinical cohort of HIV-infected patients. We defined seroreversion as the loss of reactivity in a patient who previously had a serologic test result positive for syphilis. We defined serologic failure as the lack of a 4-fold decrease in rapid plasma reagin titers 270-365 days after therapy or a 4-fold increase in titers > or =30 days after therapy. We used Cox proportional hazards models with statistical adjustments for multiple failure instances. RESULTS: One hundred eighty subjects experienced 231 cases of syphilis. The median follow-up time was 5.3 years. A total of 71 episodes of serologic failure were documented. A CD4 cell count of <200 cells/mL at the time of syphilis diagnosis was associated with an increased risk of serologic failure (adjusted hazard ratio, 2.48; 95% confidence interval, 1.26-4.88). The receipt of highly active antiretroviral therapy was associated with a 60% reduction in the rate of serologic failure (adjusted hazard ratio, 0.40; 95% confidence interval, 0.21-0.75), independent of concomitant CD4 cell response. Rapid plasma reagin seroreversion was infrequent (16.1%) and inconsistent, and it was more likely to occur among patients who received macrolides. CONCLUSION: The use of highly active antiretroviral therapy to reverse immunosuppression and the routine use of macrolides for the prevention of opportunistic infections may reduce syphilis serologic failure rates among HIV-infected patients who have syphilis.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Concerns regarding adequate treatment of syphilis among persons with HIV infection might not apply to those with HIV virologic suppression.
“concerns regarding adequate treatment of syphilis among persons with HIV infection might not apply to those with HIV virologic suppression (624,625).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [625]
The Results (Serologic failure; page unavailable) report that HAART was associated with fewer serologic failures, but explicitly state that HIV RNA level was not associated with serologic failure. The paper therefore does not support singling out virologically suppressed patients as a group for whom concerns about syphilis treatment response might not apply. (LLM, conf=0.79)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredUsing ART per current HIV guidelines might improve clinical outcomes among persons coinfected with HIV and syphilis.
“Using ART per current HIV guidelines might improve clinical outcomes among persons coinfected with HIV and syphilis”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [625]
The Discussion reports that HAART may improve syphilis serologic responses in people coinfected with HIV and syphilis, and describes those findings as likely clinically meaningful. The paper does not establish improved clinical outcomes beyond serologic measures or evaluate ART use specifically under current HIV guidelines. (LLM, conf=0.83)
Experimental — accuracy not yet measuredUnusual serological patterns such as false-negative test results and delayed seroreactivity are seen rarely.
“Unusual serological patterns such as false-negative test results and delayed seroreactivity are seen rarely.133”
From BASHH UK guidelines for the management of syphilis 2024 (2024) · cites this paper as [133]
The Results (Seroreversion; page unavailable) report how often previously positive tests became negative, but do not establish that these were false-negative results. The Discussion (page unavailable) concerns slower serologic response after treatment, not delayed seroreactivity after infection. Searches for false-negative results and delayed seroreactivity found no passage establishing that either pattern is rare. (LLM, conf=0.70)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 30 · Cited by 105
Research works printed but not linked: 1
- [16]Idsoe O Guthe T Willcox RR Penicillin in the treatment of syphilis: the experience of three decades Bull World Health Organ 1972 47 1 68 4575351 PMC2480641
- Authors
- Ghanem, K. G., Moore, R. D., Rompalo, A. M., Erbelding, E. J., Zenilman, J. M., & Gebo, K. A.
- Affiliations
- Johns Hopkins University (US)
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-07-15
- Volume
- 47
- Issue
- 2
- Pages
- 258-265
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC2562285
- OpenAlex
- W2146581862
- Cited by
- 105
- References
- 30
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 4 · 2023: 2 · 2022: 7 · 2021: 5 · 2020: 7 · 2019: 4 · 2018: 5 · 2017: 4 · 2016: 5 · 2015: 9 · 2014: 6 · 2013: 7 · 2012: 7
- FWCI
- 6.01
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (1r01ag026250-01a2)
- National Institute on Alcohol Abuse and Alcoholism (R01AA016893)
- National Institute on Aging (R01 AG026250:)
- National Institute on Drug Abuse (U01DA036935, R01DA011602, K24DA000432, K23DA000523)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD047395)
- Topics
- Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Keywords
- syphilis, HIV infection, highly active antiretroviral therapy, seroreversion, RPR, CD4 count, immunosuppression, macrolides, opportunistic infection prophylaxis, syphilis serology
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, False Negative Reactions, Female, Humans, Male, Middle Aged, Reagins, Retrospective Studies, Serologic Tests, Syphilis, Treponema pallidum, Cohort Studies, HIV Infections, Proportional Hazards Models, Disease Progression, CD4 Lymphocyte Count, Macrolides, Anti-HIV Agents, Antiretroviral Therapy, Highly Active
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
