One dose versus three weekly doses of benzathine penicillin G for patients co-infected with Hiv and early syphilis: A multicenter, prospective observational study
Journal
PLoS ONE
Journal Volume
9
Journal Issue
10
Pages
e109667
Date Issued
2014
Author(s)
Yang C.-J.
Lee N.-Y.
Chen T.-C.
Lin Y.-H.
Liang S.-H.
Lu P.-L.
Huang W.-C.
Tang H.-J.
Lee C.-H.
Lin H.-H.
Chen Y.-H.
Ko W.-C.
Abstract
Background:One dose of benzathine penicillin G (BPG) has been recommended for HIV-infected patients with early syphilis (primary, secondary, and early latent syphilis) in the sexually transmitted diseases treatment guidelines, but clinical data to support such a recommendation are limited. Copyright:Methods: We prospectively observed the serological response to 1 or 3 weekly doses of BPG in HIV-infected adults who sought treatment of early syphilis at 8 hospitals around Taiwan. Rapid plasma reagin (RPR) titers were followed every 3-6 months after treatment. The serological response was defined as a 4-fold or greater decline in RPR titers at 12 months of treatment. The missing values were treated by following the last-observed-carried-forward principle. We hypothesized that 1 dose was non-inferior to 3 weekly doses of BPG with the non-inferiority margin for the difference of serological response set to 10%.Results: Between 2007 and 2012, 573 patients completed at least 12 months of follow-up: 295 (51.5%) receiving 1 dose of BPG (1-dose group) and 278 (48.5%) 3 doses (3-dose group). Overall, 198 patients (67.1%; 95% confidence interval [Cl], 61.472.5%) in the 1-dose group achieved serological response at 12 months, as did 208 patients (74.8%; 95% Cl, 69.3-79.8%) in the 3-dose group (one-sided 95% Cl of the difference, 15.1%). In the multivariate analysis, secondary syphilis (adjusted odds ratio [AOR], 1.90; 95% Cl 1.17-3.09), RPR titer ?32 (AOR, 1.93; 95% Cl, 1.38-2.69), and 3 doses of BPG (AOR, 1.68; 95% Cl, 1.20-2.36) were independently associated with a serological response. The time to the first episode of treatment failure was 1184 (standard deviation [SD], 70.5) and 1436 (SD, 80.0) days for 1- and 3-dose group, respectively.Conclusions: Single-dose BPG resulted in a higher serological failure rate and shorter time to treatment failure than 3 weekly doses of BPG in the treatment of early syphilis in HIV-infected patients. ? 2014 Yang et al.
SDGs
Other Subjects
benzathine penicillin; reaginic antibody; benzathine penicillin; adult; antibody titer; Article; CD4 lymphocyte count; comparative effectiveness; controlled clinical trial; controlled study; dosage schedule comparison; dose response; drug dose comparison; drug dose regimen; female; follow up; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; major clinical study; male; medical history; men who have sex with men; mixed infection; multicenter study; outcome assessment; prospective study; reagin test; reinfection; retreatment; syphilis; Taiwan; treatment duration; treatment failure; blood; clinical trial; comparative study; complication; drug administration; Human immunodeficiency virus infection; Kaplan Meier method; syphilis; Adult; Coinfection; Drug Administration Schedule; Female; HIV Infections; Humans; Kaplan-Meier Estimate; Male; Penicillin G Benzathine; Prospective Studies; Syphilis
Publisher
Public Library of Science
Type
journal article