İnsan immün yetmezlik virüsü ile enfekte hastalarda sifiliz ko-enfeksiyonunun değerlendirilmesi ve rapid plasma reagin (RRP) titresinin sifiliz evresine göre takibi

Year 2023, Volume: 28 Issue: 3, 404 - 410, 28.09.2023

Neslihan Arıcı , Handan Ankaralı , Nilgün Kansak , Rıza Adaleti , Sebahat Aksaray

https://doi.org/10.21673/anadoluklin.1345710

Abstract

Amaç: HIV hastalarındaki sifiliz koenfeksiyonu gecikmiş serolojik yanıt ile ilişkilidir. Bu çalışmanın amacı, HIV/sifiliz koenfeksiyonunun sıklığı, tedavi sonrası rapid plasma reagin (RPR) titresinin izlenmesi ve serolojik yanıtı etkileyen faktörler hakkında güncel veriler elde etmektir.

Yöntemler: Ocak 2015-Mart 2023 tarihleri arasında takip edilmiş HIV hastalarının sifiliz enfeksiyonuna yönelik serolojik testleri retrospektif olarak değerlendirildi. Demografik veriler (yaş, cinsiyet), HIV RNA seviyesi, RPR, Treponema pallidum hemaglütinasyon testi (TPHA) ve sifiliz evresi hastane elektronik veri tabanından elde edildi. Serolojik yanıt, Hastalık Kontrol ve Önleme Merkezi (CDC) kriterlerine göre tanımlandı.

Bulgular: Hastaların %36,2'sinde (103/284) frengi koenfeksiyonu saptandı ve hastaların tamamı erkekti. Sifiliz evresine göre dağılım sırasıyla primer %2,9, sekonder %9,7, latent %80,6 ve nörosifiliz %6,8 şeklinde idi. Primer, sekonder ve nörosifilisi olan tüm hastalarda tedaviden sonraki 12 ay içinde RPR titresinde ≥4 kat azalma olurken, latent sifilizli iki hastada 12-24 ay içinde titrede azalma olmadı. Buna göre genel serolojik yanıt %95.8 idi. RPR titresindeki 4 kat azalmanın elde edildiği süre, sifiliz evreleri açısından karşılaştırıldığında, istatistiksel olarak anlamlı bir fark yoktu. Başlangıç RPR titresi >1: 32 olan hastalar, başlangıç RPR titresi ≤1: 32 olanlara göre daha hızlı serolojik yanıt elde etti.

Sonuç: HIV/sifiliz koenfeksiyon oranının oldukça yüksek olduğu gözlemlendi. Hastaların çoğunda CDC'nin tanımladığı zaman aralığında serolojik yanıt alınması umut vericidir. Başlangıç RPR titresi ≤32 olan hastalarda tedavi yanıtının daha uzun sürebileceği göz önünde bulundurulmalıdır. Bunun yanısıra, HIV/sifiliz ko-enfekte hastalarda serolojik yanıtla ilişkili faktörleri araştıran daha ileri prospektif çalışmalara ihtiyaç vardır.

Keywords

HIV, sifiliz, koenfeksiyon, RPR, serolojik yanıt

Supporting Institution

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Project Number

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Thanks

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Evaluation of syphilis co-infection and monitoring of rapid plasma reagin (RRP) titer according to syphilis-stage in human immunodeficiency virus-infected patients

Abstract

Aim: Syphilis co-infection in HIV-infected patients is associated by a delayed serological response. The aim of this study is to obtain current data on the frequency of HIV/syphilis co-infection, the monitoring of rapid plasma reagin (RPR) titer after treatment, and factors affecting the serologic response.

Methods: Serological tests for syphilis of HIV patients followed between January 2015 and March 2023 were evaluated retrospectively. Demografic data (age, sex), level of HIV RNA, RPR, Treponema pallidum haemagglutination test (TPHA), and syphilis stage were obtained from hospital electronic database. Serological response was defined according to Centers for Disease Control and Prevention (CDC) criteria.

Results: Syphilis co-infection was detected in 36.2% of the patients, all of them were male. Distribution of syphilis stage was primary 2.9%, secondary 9.7%, latent 80.6%, and neurosyphilis 6.8%, respectively. All patients with primary, secondary, and neurosyphilis had ≥4-fold decrease in RPR titer within 12 months after treatment, while two patients with latent syphilis didn’t have a decrease in titer within 12-24 months. Overall serologic response was 95.8%. Comparing the time to a 4-fold decrease in the RPR titer in terms of syphilis stage, there was no statistically significant difference. Patients with initial RPR titer >1: 32 achieved faster serologic response than those with initial RPR titer ≤1: 32.

Conclusion: HIV/syphilis coinfection rate was notably high. It is promising that most patients had a serologic response within the time-frame defined by the CDC. It should be considered that treatment response may take longer in patients with an initial RPR titer ≤32. Further prospective studies are needed to understand the factors associated with serologic response in HIV/syphilis co-infected patients.

Keywords

HIV, syphilis, co-infection, rapid plasma reagin, serologic response

Project Number

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