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A single dose of benzathine penicillin G is as effective as multiple doses of benzathine penicillin G for the treatment of HIV-infected persons with early syphilis.

AbstractBACKGROUND:
Treatment guidelines recommend the use of a single dose of benzathine penicillin G (BPG) for treating early syphilis in human immunodeficiency virus (HIV)-infected persons. However, data supporting this recommendation are limited. We examined the efficacy of single-dose BPG in the US Military HIV Natural History Study.
METHODS:
Subjects were included if they met serologic criteria for syphilis (ie, a positive nontreponemal test [NTr] confirmed by treponemal testing). Response to treatment was assessed at 13 months and was defined by a ≥4-fold decline in NTr titer. Multivariate Cox proportional hazard regression models were utilized to examine factors associated with treatment response.
RESULTS:
Three hundred fifty subjects (99% male) contributed 478 cases. Three hundred ninety-three cases were treated exclusively with BPG (141 with 1 dose of BPG). Treatment response was the same among those receiving 1 or >1 dose of BPG (92%). In a multivariate analysis, older age (hazard ratio [HR], 0.82 per 10-year increase; 95% confidence interval [CI], .73-.93) was associated with delayed response to treatment. Higher pretreatment titers (reference NTr titer <1:64; HR, 1.94 [95% CI, 1.58-2.39]) and CD4 counts (HR, 1.07 for every 100-cell increase [95% CI, 1.01-1.12]) were associated with a faster response to treatment. Response was not affected by the number of BPG doses received (reference, 1 dose of BPG; HR, 1.11 [95% CI, .89-1.4]).
CONCLUSIONS:
In this cohort, additional BPG doses did not affect treatment response. Our data support the current recommendations for the use of a single dose of BPG to treat HIV-infected persons with early syphilis.
AuthorsAnuradha Ganesan, Octavio Mesner, Jason F Okulicz, Thomas O'Bryan, Robert G Deiss, Tahaniyat Lalani, Timothy J Whitman, Amy C Weintrob, Grace Macalino, Brian K Agan, Infectious Disease Clinical Research Program HIV/STI Working Group
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 60 Issue 4 Pg. 653-60 (Feb 15 2015) ISSN: 1537-6591 [Electronic] United States
PMID25389249 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Copyright© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected].
Chemical References
  • Antitreponemal Agents
  • Penicillin G Benzathine
Topics
  • Adult
  • Age Factors
  • Aged
  • Antitreponemal Agents (administration & dosage)
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • HIV Infections (complications)
  • Humans
  • Injections, Intramuscular
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Penicillin G Benzathine (administration & dosage)
  • Proportional Hazards Models
  • Syphilis (complications, diagnosis, drug therapy)
  • Young Adult

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