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

作者：Ganesan Anuradha^*; Mesner Octavio; Okulicz Jason F; O'Bryan Thomas; Deiss Robert G; Lalani Tahaniyat; Whitman Timothy J; Weintrob Amy C; Macalino Grace; Agan Brian K

来源：Clinical Infectious Diseases, 2015, 60(4): 653-660.

DOI：10.1093/cid/ciu888

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

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.

• 出版日期2015-2-15