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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.
- Source :
-
BMC Infectious Diseases . 10/28/2015, Vol. 15, p1-15. 15p. 1 Diagram, 3 Charts. - Publication Year :
- 2015
-
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. [ABSTRACT FROM AUTHOR]
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 14712334
- Volume :
- 15
- Database :
- Academic Search Index
- Journal :
- BMC Infectious Diseases
- Publication Type :
- Academic Journal
- Accession number :
- 110700886
- Full Text :
- https://doi.org/10.1186/s12879-015-1209-0