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

• Published in: PloS one 2014-10, Vol.9 (10), p.e109667-e109667
• Main Authors: Yang, Chia-Jui, Lee, Nan-Yao, Chen, Tun-Chieh, Lin, Yu-Hui, Liang, Shiou-Haur, Lu, Po-Liang, Huang, Wen-Chi, Tang, Hung-Jen, Lee, Chen-Hsiang, Lin, Hsi-Hsun, Chen, Yen-Hsu, Ko, Wen-Chien, Hung, Chien-Ching
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; Adults; AIDS; Analysis; Antibiotics; Antiretroviral drugs; Care and treatment; Coinfection; Confidence intervals; Dosage; Drug Administration Schedule; Failure; Female; HIV; HIV infections; HIV Infections - complications; HIV patients; Human immunodeficiency virus; Humans; Kaplan-Meier Estimate; Male; Medical research; Medical treatment; Medicine and health sciences; Multivariate analysis; Observational studies; Patients; Penicillin; Penicillin G Benzathine - administration & dosage; Penicillin G Benzathine - therapeutic use; Penicillins; Prospective Studies; Reagin; Recommender systems; Sexually transmitted diseases; STD; Syphilis; Syphilis - blood; Syphilis - complications; Syphilis - drug therapy; Treponema pallidum
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0109667

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. 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%. 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 [CI], 61.4-72.5%) in the 1-dose group achieved serological response at 12 months, as did 208 patients (74.8%; 95% CI, 69.3-79.8%) in the 3-dose group (one-sided 95% CI of the difference, 15.1%). In the multivariate analysis, secondary syphilis (adjusted odds ratio [AOR], 1.90; 95% CI 1.17-3.09), RPR titer ≥32 (AOR, 1.93; 95% CI, 1.38-2.69), and 3 doses of BPG (AOR, 1.68; 95% CI, 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. 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.