Treatment of syphilis in HIV-infected subjects: a systematic review of the literature
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Correspondence to Dr Khalil G Ghanem, JHUBMC, ID Division, 4940 Eastern Ave, B3N, Baltimore, MD 21224, USA;
Contributors LJB: data collection, data abstraction, drafting of the manuscript. AMR/EJE/JMZ: data assessment, drafting of manuscript. KGG: data collection, data abstraction, data analysis and drafting of the manuscript.
- Accepted 18 July 2010
- Published Online First 5 October 2010
Background The optimal antimicrobial regimen to treat syphilis in HIV-infected subjects remains controversial.
Objective To systematically assess the literature for studies evaluating syphilis treatment regimens in this population.
Methods Two reviewers independently assessed studies published between 1980 and June 2008 in electronic databases, trial registries and bibliographies (with no language restrictions) for content and quality. Studies that included 10 or more people, with documented HIV status, type and duration of syphilis treatment and at least 6 months of follow-up were included. The primary outcome was syphilis serological or clinical failure stratified by syphilis stage.
Results Of 1380 unique citations, 23 studies (22 published papers and 1 conference abstract) were included in the systematic review. Owing to the significant heterogeneity among studies, pooled summary statistics could not be generated. The range of probabilities for serological failure with 2.4 million units (MU) of intramuscular benzathine penicillin G (BPG) was 6.9% (95% CI 2.6% to 14.4%) to 22.4% (11.7% to 36.6%); that of 7.2 MU of BPG in late latent syphilis was 19.4% (11.9% to 28.9%) to 31.1% (22.3% to 40.9%) and failure estimates with 18–24 MU of aqueous penicillin for the treatment of neurosyphilis were 27.3% (6.0% to 61.0%) to 27.8% (14.2% to 45.2%).
Conclusions The optimal antimicrobial regimen to treat syphilis in HIV-infected subjects is unknown; guideline recommendations in this population are based on little objective data.
Funding Funding from the National Institutes of Health (K23HD047395) was provided to KGG.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.