There is a lack of large studies appraising the effect of the human immunodeficiency virus (HIV) on the course of
syphilis since the advent of
highly active antiretroviral therapy (
HAART). We aimed to appraise the effect of HIV on clinical and serologic features of
syphilis at baseline and during follow-up in the post-
HAART era.We designed a retrospective cohort study of consecutive
syphilis cases, diagnosed between 2000 and 2007, in an academic
venereal disease center. Data were collected using standardized medical forms. Patients were treated according to the European guidelines. Serologic failure was defined as either a 4-fold rise in
Venereal Disease Research Laboratory (VDRL) titers 30-400 days posttreatment or a lack of 4-fold drop in VDRL titers at 270-400 days posttreatment.Among 279
syphilis cases with informative baseline clinical and serologic data,
HIV infection was significantly associated with men having sex with men, French origin, multiple partners, lesser usage of
condom, history of
sexually transmitted disease, early
syphilis, anal primary
chancre, and cutaneous eruption. Median baseline titer from the Treponema pallidum hemagglutination assay (TPHA) was higher in HIV-infected patients (p = 0.02).Among 144 informative
syphilis cases, there was a nonsignificant trend for a lower rate of serologic response among HIV-positive patients (91.8% vs. 98.3%, p = 0.14). Serologic failure was significantly associated with a history of previous
syphilis (p < 0.05). The median delay to serologic response was similar in HIV-positive (117 d) and in HIV-negative (123 d) patients (p = 0.44).We conclude that for patients under
HAART treatment, the effect of HIV on serologic response to
syphilis treatment is likely minimal or absent.