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- Title
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.
- Authors
Seña, Arlene C.; Xiao-Hui Zhang; Li, Trudy; He-Ping Zheng; Bin Yang; Li-Gang Yang; Salazar, Juan C.; Cohen, Myron S.; Moody, M. Anthony; Radolf, Justin D.; Tucker, Joseph D.; Zhang, Xiao-Hui; Zheng, He-Ping; Yang, Bin; Yang, Li-Gang
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
SYPHILIS treatment; HIV-positive persons; IMMUNOSPECIFICITY; SYSTEMATIC reviews; PUBLIC health; IMMUNE response; LITERATURE reviews; AGE distribution; COMPARATIVE studies; HIV infections; RESEARCH methodology; MEDICAL cooperation; RESEARCH; RESEARCH funding; SYPHILIS; VIRAL load; EVALUATION research; TREATMENT effectiveness; ANTI-HIV agents; CD4 lymphocyte count
- Publication
BMC Infectious Diseases, 2015, Vol 15, p1
- ISSN
1471-2334
- Publication type
journal article
- DOI
10.1186/s12879-015-1209-0