Management of syphilis in the HIV-infected patient: Facts and controversies
Management of syphilis in the HIV-infected patient: Facts and controversies
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DOI：
10.1016/j.clindermatol.2010.03.012
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发表时间：
2010-09-01
影响因子：
2.7
通讯作者：
Dupin, Nicolas
中科院分区：
文献类型：
--
作者：
Farhi, David;Dupin, Nicolas
在几个工业化国家的梅毒发病率在世纪之交达到历史最低水平后，现在再次上升，这可能是由于改进的艾滋病毒抗逆转录病毒治疗方案而出现的不安全性行为的结果。自艾滋病毒大流行以来，已经发表了大量关于梅毒和艾滋病毒之间相互作用的各个方面的报告。关于合并感染患者的治疗的许多问题仍然存在争议。本文对现有文献进行了批判性评估。很少有大规模、设计合理的对照研究根据艾滋病毒状况比较梅毒基线表现和治疗反应。其中的弱点是（1）患者失访率高，（2）缺乏长期随访，（3）缺乏治疗反应的金标准，（4）样本量小，以及（5）缺乏根据梅毒阶段、正在进行的抗逆转录病毒治疗、CD4细胞计数和HIV病毒载量进行分层。根据现有数据，并考虑到可能存在的发表偏倚，我们得出的结论是，即使艾滋病毒对梅毒病程有影响，但在大多数情况下影响很小，并且在临床上是可以控制的。所讨论的有争议的问题应该为未来十年的临床研究提供理论基础。 (C) 2010 Elsevier Inc. 保留所有权利。
After reaching an all time low at the turn of the millennium in several industrialized countries, the syphilis incidence is rising again, perhaps as a consequence of unsafe sexual behavior in response to improved antiretroviral therapeutic options for HIV. Since the beginning of the HIV pandemic, numerous reports on the various aspects of the interaction between syphilis and HIV have been published. Controversies persist on many issues of the management of coinfected patients. This contribution presents a critical appraisal of the available literature. Few large-scale, properly designed, controlled studies have compared syphilis baseline presentation and treatment response according to HIV status. Among the weakness are (1) high rates of patients lost to follow-up, (2) lack of long-term follow-up, (3) lack of gold standard criteria for treatment response, (4) small sample size, and (5) lack of stratification according to syphilis stage, ongoing antiretroviral treatment, CD4 cell count and HIV viral load. From the available data, and given the ever-possible publication bias, we conclude that if HIV has an effect on the course of syphilis, it is small and clinically manageable in most cases. The controversial issues discussed should furnish the rational for clinical research during the forthcoming decade. (C) 2010 Elsevier Inc. All rights reserved.