Clinical outcomes of syphilis in HIV-negative and HIV-positive MSM: occurrence of repeat syphilis episodes and non-treponemal serology responses

2021 ◽  
pp. sextrans-2020-054887
Author(s):  
Silvia Achia Nieuwenburg ◽  
Ricardo Jamie Sprenger ◽  
Maarten Franciscus Schim van der Loeff ◽  
Henry John Christiaan de Vries
Keyword(s):  
Hiv Infection ◽  
Controlled Trial ◽  
Clinical Manifestations ◽  
Response To Treatment ◽  
Disease Stage ◽  
Hiv Positive ◽  
Sexual Risk Behaviour ◽  
Serological Response ◽  
History Of ◽  
Hiv Negative

ObjectivesHIV-positive men who have sex with men (MSM) may be at a higher risk of repeat syphilis, have different clinical manifestations and have a different serological response to treatment compared with HIV-negative MSM. The objective of this study was to assess whether HIV-negative and HIV-positive MSM with infectious syphilis (primary, secondary or early latent) differed in history of previous syphilis episodes, disease stage and non-treponemal titre of initial and repeat episodes, and the titre response 6 and 12 months after treatment. Furthermore, determinants associated with an inadequate titre response after treatment were explored.MethodsThis retrospective analysis used data of five longitudinal studies (four cohorts; one randomised controlled trial) conducted at the STI clinic in Amsterdam, the Netherlands. Participants were tested for syphilis and completed questionnaires on sexual risk behaviour every 3–6 months. We included data of participants with ≥1 syphilis diagnosis in 2014–2019. Pearson’s χ² test was used to compare HIV-negative and HIV-positive MSM in occurrence of previous syphilis episodes, disease stage of initial and repeat syphilis episode and non-treponemal titre treatment responses.ResultsWe included 355 participants with total 459 syphilis episodes. HIV-positive MSM were more likely to have a history of previous syphilis episodes compared with HIV-negative MSM (68/90 (75.6%) vs 96/265 (36.2%); p<0.001). Moreover, HIV-positive MSM with repeat syphilis were less often diagnosed with primary syphilis (7/73 (9.6%) vs 36/126 (28.6%)) and more often diagnosed with secondary syphilis (16/73 (21.9%) vs 17/126 (13.5%)) and early latent syphilis (50/73 (68.5%) vs 73/126 (57.9%)) (p=0.005). While not significantly different at 12 months, HIV-negative MSM were more likely to have an adequate titre response after 6 months compared with HIV-positive MSM (138/143 (96.5%) vs 66/74 (89.2%); p=0.032).ConclusionsIn repeat syphilis, HIV infection is associated with advanced syphilis stages and with higher non-treponemal titres. HIV infection affects the serological outcome after treatment, as an adequate titre response was observed earlier in HIV-negative MSM.

Management of syphilis in HIV-positive individuals

Sexual Health ◽  
2015 ◽  
Vol 12 (2) ◽  
pp. 135 ◽  
Author(s):  
Fiona V. Cresswell ◽  
Martin Fisher
Keyword(s):  
Antibiotic Treatment ◽  
Controlled Trial ◽  
Clinical Manifestations ◽  
Response To Treatment ◽  
Penicillin G ◽  
Neurological Involvement ◽  
Hiv Positive ◽  
Reference Laboratory ◽  
Serological Response ◽  
Randomised Controlled

Since the turn of the millennium a sustained outbreak of syphilis among men who have sex with men continues, approximately 20–50% of whom have concurrent HIV infection. In this paper we aim to explore the controversies that exist around the management of syphilis in HIV-positive individuals. Not only do HIV-positive people have different clinical manifestations of syphilis they have higher rates of asymptomatic neurological involvement, slower serological response to treatment and higher serological failure than HIV-negative individuals in most studies. Whether long-term clinical outcomes are different or affected by the antibiotic regimen selected remains to be established. The optimal antimicrobial regimen to treat syphilis in HIV is unknown due to a dearth of randomised controlled trial data. International guidelines state that the antibiotic management of syphilis is the same regardless of HIV status, with early syphilis treated with a single dose of benzathine penicillin G 2.4mU intrmuscularly. In practice, however, the majority of surveyed clinicians do treat HIV-positive people with more intensive antibiotics suggesting a lack of faith in guidelines. Factors which appear to affect the likelihood of developing neurological disease include CD4+ count of <350 cells/μL, absence of antiretroviral therapy, rapid plasma regain (RPR) or venereal diseases reference laboratory titre (VDRL) >1 : 32, late-latent disease or lack of response to standard antibiotic treatment. We recommend a low-threshold for offering antibiotic treatment effective against neurosyphilis in HIV-positive people with syphilis, especially if they exhibit any of the above factors.

scholarly journals Slow clinical improvement after treatment initiation in Leishmania/HIV coinfected patients

2012 ◽  
Vol 45 (2) ◽  
pp. 147-150 ◽  
Author(s):  
Guenael Freire de Souza ◽  
Fernando Biscione ◽  
Dirceu Bartolomeu Greco ◽  
Ana Rabello
Keyword(s):  
Hiv Infection ◽  
Clinical Response ◽  
Clinical Picture ◽  
Treatment Initiation ◽  
Early Recognition ◽  
Response To Treatment ◽  
Hiv Positive ◽  
Large Area ◽  
Belo Horizonte ◽  
Hiv Negative

INTRODUCTION: In Brazil there is a large area of overlap of visceral leishmaniasis (VL) and HIV infection, which favored a increased incidence of coinfection Leishmania/HIV. METHODS: This study evaluated 65 consecutive patients with VL and their clinical response to treatment in two health care settings in Belo Horizonte, Brazil. RESULTS: At baseline, the clinical picture was similar between both groups, although diarrhea and peripheral lymphadenomegaly were more frequent in HIV-infected subjects. HIV-positive patients had lower median blood lymphocyte counts (686/mm³ versus 948/mm³p = 0.004) and lower values of alanine aminotransferase (ALT) (48IU/L versus 75.6IU/L p = 0.016) than HIV-negative patients. HIV-positive status (hazard ratio = 0.423, p = 0.023) and anemia (HR = 0.205, p = 0.002) were independent negative predictors of complete clinical response following antileishmanial treatment initiation. CONCLUSIONS: This study reinforces that all patients with VL should be tested for HIV infection, regardless of their clinical picture. This practice would allow early recognition of coinfection with initiation of antiretroviral therapy and, possibly, reduction in treatment failure.

scholarly journals Neurocysticercosis and HIV Infection: what can we learn from the published literature?

2019 ◽  
Vol 77 (5) ◽  
pp. 357-365 ◽  
Author(s):  
Omar Herrera Vazquez ◽  
Matthew L. Romo ◽  
Agnès Fleury
Keyword(s):  
Hiv Infection ◽  
Immune Status ◽  
Taenia Solium ◽  
Response To Treatment ◽  
Hiv Positive ◽  
Historical Series ◽  
Immunodeficiency Virus ◽  
The Central Nervous System ◽  
Published Research ◽  
Hiv Negative

ABSTRACT Infections caused by the human immunodeficiency virus (HIV) and by the larvae of Taenia solium (i.e., cysticercosis) are still widespread in many developing countries. Both pathologies modify host immune status and it is possible that HIV infection may modulate the frequency and pathogeny of cysticercosis of the central nervous system (i.e., neurocysticercosis [NCC]). Objective: To describe published cases of NCC among HIV-positive patients and to evaluate whether the characteristics of NCC, including frequency, symptoms, radiological appearance, and response to treatment differed between HIV-positive and HIV-negative patients. Methods: Forty cases of NCC/HIV co-infected patients were identified in the literature. Clinical and radiological characteristics, as well as response to treatment, were compared with non-matching historical series of NCC patients without HIV infection. Results: Most of these patients had seizures and multiple vesicular parasites located in parenchyma. Clinical and radiological characteristics were similar between HIV-positive and HIV-negative patients with NCC, as well as between immunocompromised and non-immunocompromised HIV-positive patients. Conclusion: Our review did not reveal clear interactions between HIV and NCC. This may be partially due to the small number of cases and reliance on published research. A systematic, multi-institutional effort aiming to report all the cases of this dual pathology is needed to confirm this finding and to clarify the possible relationship between both pathogens.

scholarly journals Measles in adults: A comparison of hospitalised HIV-infected and HIV-uninfected patients

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Nina E. Diana ◽  
Charles Feldman
Keyword(s):  
Hiv Infection ◽  
Hospital Stay ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Length Of Hospital Stay ◽  
Adult Patients ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Hiv Negative

Background: Although measles is traditionally a childhood illness, there are an increasing number of adult cases. Despite both measles and HIV infection being endemic in sub-Saharan Africa, there are little data regarding outcomes in co-infected patients.Objectives: Compare demographic, clinical, laboratory and radiographic features, as well as outcome (length of hospital stay, complications and mortality) between HIV-infected and HIV-uninfected adult patients admitted with confirmed measles.Methods: We conducted a retrospective record review of adult patients with confirmed measles who were admitted to the Infectious Diseases Unit at the Charlotte Maxeke Johannesburg Academic Hospital during the peak of the 2009 and 2010 South African measles outbreak. The data collected included demographic, clinical and laboratory parameters, as well as outcomes.Results: Of the 33 confirmed measles cases admitted, 24 patients were tested for HIV infection and 18 tested seropositive. There were no significant differences in the demographics, clinical findings or laboratory data when comparing the HIV-positive and HIV-negative cases. Serious clinical manifestations were seen more frequently in HIV-positive patients (odds ratio [OR] 5, 95% confidence interval [CI] 0.48–51.8, p = 0.34). One of the six patients testing HIV-negative developed pneumonia, while six of the 18 HIV-positive patients had a course complicated by pneumonia. Five of these HIV-positive patients required admission to the intensive care unit, three developing respiratory failure necessitating mechanical ventilation. HIV-positive patients had several other manifestations, including acute kidney injury, purulent conjunctivitis, pancreatitis and encephalitis. HIV-positive patients had a significantly longer hospital stay (p = 0.03). There were three deaths in the HIV-positive group, but none in the HIV-negative group (OR 2.9, 95% CI 0.13–65.3, p = 0.55).Conclusion: Our study provides data on the largest series of hospitalised adults infected with HIV and co-infected with measles. More severe consequences seemed to occur in hospitalised HIV-positive patients.

scholarly journals Clinical signs of tuberculosis relapses in HIV patients

2020 ◽  
Vol 98 (6) ◽  
pp. 32-35
Author(s):  
E. Yu. Zorkаltsevа ◽  
Yu. O. Egorovа
Keyword(s):  
Central Nervous System ◽  
Hiv Infection ◽  
Treatment Efficacy ◽  
Medical Records ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Hiv Positive ◽  
Hiv Patients ◽  
The Central Nervous System ◽  
Hiv Negative

The objective: to study clinical manifestations of tuberculosis relapses and their treatment outcomes in patients with HIV infection.Subjects and Methods. 132 medical records of patients with tuberculosis relapses were analyzed; 69 of them were HIV-positive and 63 were HIV-negative. All of them were admitted to Irkutsk Regional Clinical Tuberculosis Hospital from 2016 to 2019, and then continued treatment of tuberculosis on the out-patient basis. Treatment efficacy was assessed in February 2020.Results. More severe clinical forms of tuberculosis relapses were typical of HIV patients including generalized forms affecting the central nervous system. Therefore, among these patients, the mortality rate is significantly higher (24.6%) than in tuberculosis relapses with no concurrent HIV infection (6.3%), p ≤ 0.05.

scholarly journals Course of HBV-infection in HIV-infected and HIV-non-infected Pregnant women

2018 ◽  
Vol 25 (4) ◽  
Author(s):  
Galyna Mateyko ◽  
Maryana Matvisiv
Keyword(s):  
Hiv Infection ◽  
Pregnant Women ◽  
Clinical Laboratory ◽  
Clinical Manifestations ◽  
Hbv Infection ◽  
Hiv Positive ◽  
Carrier Status ◽  
Hbsag Carrier ◽  
Hiv Positive Women ◽  
Hiv Negative

The objective of the work – is to study the course of HBV-infection in pregnant women, infected and uninfected with HIV, based on the analysis of clinical-laboratory parameters. Materials and methods. HBV-infection was diagnosed in 5.6% of women with negative HIV-status and in 9.4% positive with HIV. To verify the diagnosis of HBV-infection, the data of anamnesis, clinical examination, laboratory tests: general clinical, biochemical, EIA, PCR, and VL in each trimester of pregnancy were used. Research. In HIV-negative pregnant women, 71.6% of the patients were diagnosed with HBsAg carrier status and 28.4% – the replication stages. Replication stages were only in HIV-positive patients. The frequency of clinical manifestations of CHB is higher in HIV-positive women – it is 33.33% vs 10.00% in HIV-negative (p<0.05), in a significantly lower rate of cytolysis – 11.11% vs 45.00% (p< 0.001), which did not increase up to the childbirth. The rate of VL of HBV increased before the childbirth in 63.3% of pregnant women without HIV-infection, and in 36.7% it did not change. Thus, in 83.3% of HIV-infected, it decreased to the threshold, and in 16.7% it hasn’t changed (p<0.01). During pregnancy, the immunotolerant phase of CHB in women of both groups was not transformed into immunoactive, and in HIV-negative pregnant women – the carrier status of HBsAg to the replicative form. Conclusion. In pregnant women with HIV-infection the incidence of replicative forms of HBV-infection is 3.5 times than in pregnant women without HIV-infection, the HBsAg carrier status is not determined. HIV-immunosuppression is accompanied by the prevalence of the immunotolerant phase of CHB (88.9%) with subclinical course without disturbance of pigmentary metabolism and cytolysis increase against the background of a decrease of VL HBV up to the threshold in 83.3% (p<0.01). The inverse weak correlation between the level of CD4 + T-lymphocytes and VL HBV was determined. In HIV-negative pregnancies, latent forms of HBV-infection prevail (71.6%). Replicative forms are characterized by a low degree (80.0%) of HBV viremia (p<0.05) with minimal cytolysis in 43.3% of women (p<0.001), which did not change during pregnancy.

scholarly journals Alcohol Abuse and Stage of HIV Disease in Intravenous Drug Abusers

1996 ◽  
Vol 89 (7) ◽  
pp. 389-392 ◽  
Author(s):  
Gerond Lake-Bakaar ◽  
Roger Grimson
Keyword(s):  
Alcohol Consumption ◽  
Alcohol Abuse ◽  
Hiv Positive ◽  
Drug Abusers ◽  
Hiv Disease ◽  
Needle Sharing ◽  
Heavy Drinkers ◽  
History Of ◽  
Intravenous Drug Abusers ◽  
Hiv Negative

Our objective was to identify factors that might correlate with human immunodeficiency virus (HIV) disease stage in intravenous drug abusers (IVDA). Particular attention was given to alcohol abuse. We accordingly explored in a cross-sectional study the relation between stage of HIV disease and age, sex, needle sharing, ethnicity, self-reported history of alcohol consumption and CAGE scores. IVDA from a single municipal hospital were subdivided into three groups according to HIV disease status. Group 1 comprised 42 individuals with AIDS; group 2 comprised 114 who were HIV positive but without AIDS; and group 3 comprised 52 who were HIV negative. Information on alcohol consumption and CAGE responses were obtained by questionnaire and interview. Discriminant analysis indicated that alcohol abuse, assessed either by self-reported consumption or by CAGE scores, was significantly more common in the AIDS group than in either the HIV positive or the HIV negative groups, when controlled for age, sex, and needle sharing status. The relative risk of AIDS was 3.8 times higher in the heavy drinkers than in moderate drinkers. Needle sharing was also more common in the AIDS group than in the HIV positive or HIV negative groups when the other factors were controlled for. AIDS was more common in black than white IVDA, and this increased frequency did not appear related to alcohol consumption since the distribution of heavy drinkers within each category of HIV disease did not differ within the ethnic groups. These data indicate that a history of heavy alcohol consumption is more common in IVDA with AIDS than in IVDA at earlier stages of HIV disease.

Abstract WP426: Subarachnoid Hemorrhage in patients infected with Human Immunodeficiency Virus

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Haralabos Zacharatos ◽  
Malik M Adil ◽  
Ameer E Hassan ◽  
Sarwat I Gilani ◽  
Adnan I Qureshi
Keyword(s):  
Human Immunodeficiency Virus ◽  
Subarachnoid Hemorrhage ◽  
Blood Transfusion ◽  
Hospital Mortality ◽  
Hiv Infection ◽  
The United States ◽  
Hiv Positive ◽  
Published Data ◽  
Immunodeficiency Virus ◽  
Hiv Negative

Background: There is limited data regarding the unique attributes of ischemic stroke among patients infected with human immunodeficiency virus (HIV). There is no published data regarding the occurrence and outcomes of subarachnoid hemorrhage (SAH) among HIV infected persons. Methods: The largest all-payer Nationwide Inpatient Sample (NIS 2002-2010) data was used to identify and analyze all patients presenting with the primary diagnosis of SAH in the United States. Among this cohort, we identified the patients who were not HIV positive and those who were HIV positive. Patient demographics, medical co-morbidities, in-hospital complications, in-hospital procedures, and discharge disposition were compared between the two groups. The association between HIV infection and outcomes was evaluated in multivariate analysis after adjusting for potential confounders. Results: Of the 351,491 patients admitted with SAH, 1367 (0.39%) were infected with HIV. HIV infected patients were younger, mean age [±SD] of 45 ±14.2 years versus those who were not 58±19 years, (p<0.0001). The rate of blood transfusion [27,286 (7.8%) versus 245.6 (18%), p=0.0003], mechanical ventilation [51,199 (14.6%) versus 316.1(23.1%), p=0.008], and sepsis [14,644 (4.2%) versus 236.1 (17.3%), p<0.0001] was significantly higher among HIV infected patients. After adjusting for age, gender, hypertension, coagulopathy, atrial fibrillation, renal failure, and dyslipidemia, HIV negative patients had a significantly higher rate of discharge to home (odds ratio [OR] 1.9, 95% CI: 1.4-2.6, p<0.0001) and lower in-patient mortality (OR 0.4, 95% CI: 0.3-0.5, p<0.001). Further adjustment for blood transfusion and sepsis reduced the odds of discharge to home for the HIV negative patients, from 1.9 to 1.7 but did not affect in-hospital mortality. Conclusion: The in-hospital mortality in HIV infected patients with SAH is higher despite these patients being younger than non-HIV infected patients. We believe that this study provides a nationwide perspective which may have some important implications for early recognition and diagnosis of HIV-infection in SAH patients.

scholarly journals Anolunula in Fingernails among Patients Infected with HIV

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Pratik Gahalaut ◽  
Nitin Mishra ◽  
Sandhya Chauhan ◽  
Mir Mubashir Ali ◽  
Madhur Kant Rastogi ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Cross Sectional Study ◽  
Negative Control ◽  
Hiv Positive ◽  
Control Group ◽  
Cross Sectional ◽  
Significant Difference ◽  
Stage 1 ◽  
And Control ◽  
Hiv Negative

Lunula is the white, half-moon shaped area seen in proximal ends of some nails. Though a few studies have described the nail changes that can occur in association with HIV infection, none of these paid much attention to lunula. Aims and Objectives. To study the lunula in fingernails among HIV infected patients. Materials and Methods. An observational, cross-sectional study to record presence of lunula in 168 HIV-positive patients and compare it with age and sex matched 168 healthy HIV-negative control. Anolunula (absence of lunula) in HIV-positive patients was correlated with CD4 counts, stages of HIV infection, time since patient was diagnosed as HIV-positive, and status of antiretroviral therapy. Results. Anolunula was present in significantly more fingernails in HIV-positive patients compared to HIV-negative controls. There was a highly significant difference for total anolunula (anolunula in all fingernails) in study and control group. Incidence of total anolunula was directly proportional to the stage of HIV infection, increasing progressively as the HIV infection advances from stage 1 to stage 4. Conclusion. Absence of lunula is related to not only HIV infection per se but also the stages of HIV infection.

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