13/02/2010

Syphilis does not worsen HIV disease progression

Concurrent infection with syphilis does not lead to accelerated HIV disease progression, even though it may be associated with temporary changes in CD4 cell count and HIV viral load, according to a study reported in the January 2010 International Journal of STD & AIDS.

Syphilis, a sexually transmitted infection caused by Treponema pallidum bacteria, is common in people with HIV, but the effects of syphilis on HIV disease progression (time to an AIDS diagnosis or death) is not fully understood. Some research, however, has shown that CD4 cell counts may transiently decrease and HIV viral loads may temporarily increase during syphilis episodes.

To explore this issue, Amy Weintrob from the Uniformed Services University and colleagues prospectively analyzed data from 2239 HIV positive individuals with an estimated date of HIV seroconversion who received care through U.S. military medical facilities.

The researchers performed a multivariate analysis with a cut-off at the time of combination antiretroviral therapy (ART) initiation or the last visit. They adjusted for potentially confounding factors including age, sex, race/ethnicity, CD4 count, and hepatitis B or C coinfection.

Results

205 patients (9.2%) in the cohort had confirmed syphilis and 66 participants (2.9%) were judged to have probable syphilis.

In the multivariate analysis, syphilis (confirmed + probable) was not associated with increased risk of progression to AIDS or death (hazard ratio 0.99, where 1.0 indicates no difference).

Treating ART as a time-varying covariate did not significantly alter the results.

Limiting the analysis to only confirmed syphilis also did not significantly change the results.

Based on these findings, the study authors concluded, "Despite transient changes in CD4 counts and viral loads, syphilis does not appear to affect HIV disease progression."

Uniformed Services University, Infectious Disease Clinical Research Program, Bethesda, MD; Walter Reed Army Medical Center, Washington, DC; Biostatistics Research Branch, SAIC-Frederick, Frederick, MD; Biostatistics Research Branch, National Institute of Allergy and Infectious Disease, NIH, Bethesda, MD; San Antonio Military Medical Center, San Antonio, Texas; National Naval Medical Center, Bethesda, MD; Naval Medical Center San Diego, San Diego, CA.

By Liz Highleyman

Reference
AC Weintrob, W Gu, J Qin, and others. Syphilis co-infection does not affect HIV disease progressio

HIVandHepatitis.com

http://www.hivandhepatitis.com/

http://www.hivandhepatitis.com/recent/2010/0212_2010_c.html

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