|
Syphilis infection does not have virological-immunological interferences with the course of HIV disease
R. Manfredi, L. Calza
University of Bologna, S. Orsola Hospital, Infectious Diseases, Bologna, Italy
Background: The reciprocal influence of HIV infection and syphilis are not completely understood.
Patients-Methods: After the recent evidences of a recrudescence of sexually-transmitted diseases (STD) during HIV infection, since the year 2001 we carried out an observational study on a cohort of >1,000 HIV-infected patients (p). Fifty-4 p (36 homo-bisexuals and 18 heterosexuals, aged 23-58 years) were identified as novel cases of syphilis (S) (secondary S in 39 cases, primary or latent disease in the remaining episodes).
Results: All p were assessed and treated based on standardized protocols, and followed for the 12-24 subsequent months. Immunological data including at least 6 months preceding S and at least 9 months following S were available. All p save six took HAART, according to current international recommendations. During the over-18-month observation period, no statistically significant trend of laboratory parameters of HIV disease was seen in our HIV-infected p co-infected with S.
Conclusions: Although interactions between S and HIV were not deeply investigated until now, the HIV-related quantitative and functional damage of cell-mediated immunity could modify the course of S. Concurrently, during S an impairment of cellular migration and clearance, and cytokine network, were documented, together with an increased lymphoid cell apoptosis. However, it remains difficult that a non-opportunistic disease like S may trigger pathogenetic mechanisms capable of infuencing significantly the HIV disease course, especially when an effective HAART treatment concurs. While we agree with the concerns related to STD in p with HIV or exposed to HIV, differently from literature data (Buchacz K, AIDS 2004;18:2075), in our experience syphilis does not seem to modify the laboratory course of HIV infection. Although health care givers should take into consideration all suspected STD in HIV-infected p, only prospective case-control studies may answer questions associated with the potential existence of bidirectional pathogenetic-clinical interactions between S and HIV infection.
|