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BMC Infect Dis. 2015 Oct 28;15:479. doi: 10.1186/s12879-015-1209-0.

A systematic review of syphilis serological treatment outcomes in HIV-infected and HIV-uninfected persons: rethinking the significance of serological non-responsiveness and the serofast state after therapy.

Author information

1
Department of Medicine, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. idrod@med.unc.edu.
2
Sexually Transmitted Diseases Department, Guangdong Provincial Dermatology Hospital, Guangzhou, China. zhangxiaohui360@163.com.
3
School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. trudy_li@med.unc.edu.
4
Sexually Transmitted Diseases Department, Guangdong Provincial Dermatology Hospital, Guangzhou, China. zhhpf@hotmail.com.
5
Sexually Transmitted Diseases Department, Guangdong Provincial Dermatology Hospital, Guangzhou, China. yangbin101@hotmail.com.
6
Sexually Transmitted Diseases Department, Guangdong Provincial Dermatology Hospital, Guangzhou, China. yanglg3@hotmail.com.
7
Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Connecticut and Connecticut Children's Medical Center, Farmington, Connecticut, USA. jsalazar@uchc.edu.
8
Department of Medicine, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. mscohen@med.unc.edu.
9
Department of Pediatrics, Division of Pediatric Infectious Diseases, Duke University, Durham, North Carolina, USA. tony.moody@duke.edu.
10
Duke Human Vaccine Institute, Duke University, Durham, North Carolina, USA. tony.moody@duke.edu.
11
Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Connecticut and Connecticut Children's Medical Center, Farmington, Connecticut, USA. jradolf@uchc.edu.
12
Department of Medicine, UConn Health, Farmington, Connecticut, USA. jradolf@uchc.edu.
13
Department of Medicine, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. jdtucker@med.unc.edu.

Abstract

BACKGROUND:

Syphilis remains a global public health threat and can lead to severe complications. In addition to resolution of clinical manifestations, a reduction in nontreponemal antibody titers after treatment is regarded as "proof of cure." However, some patients manifest < 4-fold decline ("serological non-response") or persistently positive nontreponemal titers despite an appropriate decline ("serofast") that may represent treatment failure, reinfection, or a benign immune response. To delineate these treatment phenomena, we conducted a systematic review of the literature regarding serological outcomes and associated factors among HIV-infected and -uninfected subjects.

METHODS:

Six databases (PubMed, Embase, CINAHL, Web of Science, Scopus, and BIOSIS) were searched with no date restrictions. Relevant articles that evaluated serological treatment responses and correlates of serological cure (≥ four-fold decline in nontreponemal titers) were included.

RESULTS:

We identified 1693 reports in the literature, of which 20 studies met selection criteria. The median proportion of patients who had serological non-response was 12.1% overall (interquartile range, 4.9-25.6), but varied depending on the time points after therapy. The serofast proportion could only be estimated from 2 studies, which ranged from 35.2-44.4%. Serological cure was primarily associated with younger age, higher baseline nontreponemal titers, and earlier syphilis stage. The relationship between serological cure and HIV status was inconsistent; among HIV-infected patients, CD4 count and HIV viral load was not associated with serological cure.

CONCLUSIONS:

Serological non-response and the serofast state are common syphilis treatment outcomes, highlighting the importance of determining the immunological and clinical significance of persistent nontreponemal antibody titers after therapy.

PMID:
26511465
PMCID:
PMC4625448
DOI:
10.1186/s12879-015-1209-0
[Indexed for MEDLINE]
Free PMC Article

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