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Syphilis increases HIV viral load and decreases CD4 cell
counts in HIV-infected patients with new syphilis infections.
AIDS 2004;18(15):2075-2079.
Buchacz K, Patel P, Taylor M, Kerndt PR, Byers RH, Holmberg SD, Klausner
JD.
Abstract
BACKGROUND: Syphilitic ulcers are known to facilitate the transmission of HIV
infection, but the effect of syphilis infection on HIV viral loads and CD4
cell counts is poorly understood. METHODS: We abstracted medical records
for HIV-infected male syphilis patients seen at three clinics in San Francisco
and Los Angeles from January 2001 to April 2003. We compared plasma HIV-RNA
levels and CD4 cell counts during syphilis infection with those before syphilis
infection and after syphilis treatment, using the Wilcoxon signed rank test.
RESULTS: Fifty-two HIV-infected men with primary or secondary syphilis had
HIV viral load and CD4 cell count data available for analysis; 30 (58%) were
receiving antiretroviral therapy. Viral loads were higher during syphilis
compared with pre-syphilis levels by a mean of 0.22 RNA log10 copies/ml (P
= 0.02) and were lower by a mean of -0.10 RNA log10 copies/ml (P = 0.52)
after syphilis treatment. CD4 cell counts were lower during syphilis infection
than before by a mean of -62 cells/mm3 (P = 0.04), and were higher by a mean
of 33 cells/mm3 (P = 0.23) after syphilis treatment. Increases in the HIV
viral load and reductions in the CD4 cell count were most substantial in
men with secondary syphilis and those not receiving antiretroviral therapy.
CONCLUSION: Syphilis infection was associated with significant increases
in the HIV viral load and significant decreases in the CD4 cell count. The
findings underscore the importance of preventing and promptly treating syphilis
in HIV-infected individuals.