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Clin Infect Dis. 2015 Feb 15;60(4):653-60. doi: 10.1093/cid/ciu888. Epub 2014 Nov 10.

A single dose of benzathine penicillin G is as effective as multiple doses of benzathine penicillin G for the treatment of HIV-infected persons with early syphilis.

Author information

  • 1Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland Walter Reed National Military Medical Center, Washington, District of Columbia.
  • 2Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
  • 3Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland San Antonio Military Medical Center, Texas.
  • 4Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland Naval Medical Center San Diego, California.
  • 5Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland Naval Medical Center Portsmouth, Virginia.

Abstract

BACKGROUND:

Treatment guidelines recommend the use of a single dose of benzathine penicillin G (BPG) for treating early syphilis in human immunodeficiency virus (HIV)-infected persons. However, data supporting this recommendation are limited. We examined the efficacy of single-dose BPG in the US Military HIV Natural History Study.

METHODS:

Subjects were included if they met serologic criteria for syphilis (ie, a positive nontreponemal test [NTr] confirmed by treponemal testing). Response to treatment was assessed at 13 months and was defined by a ≥4-fold decline in NTr titer. Multivariate Cox proportional hazard regression models were utilized to examine factors associated with treatment response.

RESULTS:

Three hundred fifty subjects (99% male) contributed 478 cases. Three hundred ninety-three cases were treated exclusively with BPG (141 with 1 dose of BPG). Treatment response was the same among those receiving 1 or >1 dose of BPG (92%). In a multivariate analysis, older age (hazard ratio [HR], 0.82 per 10-year increase; 95% confidence interval [CI], .73-.93) was associated with delayed response to treatment. Higher pretreatment titers (reference NTr titer <1:64; HR, 1.94 [95% CI, 1.58-2.39]) and CD4 counts (HR, 1.07 for every 100-cell increase [95% CI, 1.01-1.12]) were associated with a faster response to treatment. Response was not affected by the number of BPG doses received (reference, 1 dose of BPG; HR, 1.11 [95% CI, .89-1.4]).

CONCLUSIONS:

In this cohort, additional BPG doses did not affect treatment response. Our data support the current recommendations for the use of a single dose of BPG to treat HIV-infected persons with early syphilis.

KEYWORDS:

HIV-infected persons; benzathine penicillin G; early syphilis; treatment response

PMID:
25389249
DOI:
10.1093/cid/ciu888
[PubMed - indexed for MEDLINE]
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