One dose versus three weekly doses of benzathine penicillin G for patients co-infected with Hiv and early syphilis: A multicenter, prospective observational study

Chia Jui Yang, Nan Yao Lee, Tun Chieh Chen, Yu Hui Lin, Shiou Haur Liang, Po Liang Lu, Wen Chi Huang, Hung Jen Tang, Chen Hsiang Lee, Hsi Hsun Lin, Yen Hsu Chen, Wen Chien Ko, Chien Ching Hung

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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.

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.

Original languageEnglish
Article numbere109667
JournalPloS one
Volume9
Issue number10
DOIs
Publication statusPublished - 2014 Oct 6

All Science Journal Classification (ASJC) codes

  • General

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