Preview

ВИЧ-инфекция и иммуносупрессии

Расширенный поиск

ПРОБЛЕМЫ ДИАГНОСТИКИ И ЛЕЧЕНИЯ СИФИЛИСА ПРИ КОИНФЕКЦИИ ВИРУСОМ ИММУНОДЕФИЦИТА ЧЕЛОВЕКА

https://doi.org/10.22328/2077-9828-2018-10-2-43-53

Полный текст:

Аннотация

Обзорная статья посвящена особенностям диагностики и лечения сифилиса, развивающегося на фоне ВИЧ-инфекции. У небольшого числа ВИЧ-инфицированных больных могут отмечаться ложноотрицательные и ложноположительные результаты серологических реакций на сифилис. Пациенты с коинфекцией подвержены более высокому риску возникновения специфических поражений нервной системы, органов зрения и слуха, у них выше вероятность неудач в лечении сифилиса и возникновения нейрорецидивов. Эффективность терапии нейросифилиса на фоне коинфекции трудно оценить, так как нормализация состава СМЖ у ВИЧ-позитивных пациентов происходит медленнее, чем у ВИЧ-негативных. В ближайшие годы число случаев сочетанных заражений сифилисом и ВИЧ-инфекцией будет неминуемо увеличиваться. В связи с этим необходимо всестороннее изучение проблемы коинфекции и совершенствование подходов к ведению больных на основе принципов доказательной медицины.

Об авторах

Т. В. Красносельских
ФГБОУ ВО ПСПбГМУ им. И.П.Павлова Минздрава России
Россия

Красносельских Татьяна Валерьевна — доктор медицинских наук, профессор кафедры дерматовенерологии с клиникой 

197022, Санкт-Петербург, ул. Льва Толстого, 6–8, корп. 4



Е. Б. Манашева
ФГБОУ ВО ПСПбГМУ им. И.П.Павлова Минздрава России
Россия

Манашева Елизавета Борисовна — старший лаборант кафедры дерматовенерологии с клиникой 

197022, Санкт-Петербург, ул. Льва Толстого, 6–8, корп. 4



М. А. Гезей
СПб ГБУЗ «Центр СПИД и инфекционными заболеваний»
Россия

Гезей Мария Александровна — врач 

190103, СанктПетербург, наб. Обводного канала, 179



Список литературы

1. Потекаев Н.Н., Фриго Н.В., Алмазова А.А., Лебедева Г.А. Эпидемиология сифилиса в современных условиях // Клиническая дерматология и венерология, 2015; (1): 22–34.

2. Кубанова А.А., Кубанов А.А., Мелехина Л.Е., Богданова Е.В. Организация оказания медицинской помощи по профилю «дерматовенерология» в Российской Федерации. Динамика заболеваемости инфекциями, передаваемыми половым путем, болезнями кожи и подкожной клетчатки, 2013–2015 гг. // Вестник дерматологии и венерологии, 2016; (3): 12–28.

3. Коробко А.В., Орлова И.А., Смирнова Н.В., Дудко В.Ю., Смирнова И.О., Смирнова Т.С., Литвиненко И.В., Пирятинская А.Б., Севашевич А.В., Гайворонская О.В., Иванов А.М. Сифилис у пациентов с ВИЧ-инфекцией — значение медико-социальных факторов в развитии сочетанной инфекции // ВИЧ-инфекция и иммуносупрессии, 2014; 6 (4): 57–63.

4. Федеральные клинические рекомендации по ведению больных сифилисом. М., 2015. 45 c. [Federal guidelines for the management of patients with syphilis. Moscow, 2015. 45 p. (In Russ.)].

5. Schöfer H., Imhof M., Thoma-Greber E., Brockmeyer N.H., Hartmann M., Gerken G., Pees H.W., Rasokat H., Hartmann H., Sadri I., Emminger C., Stellbrink H.J., Baumgarten R., Plettenberg A. Active syphilis in HIV infection: a multicentre retrospective survey. The German AIDS Study Group (GASG). Genitourinary Medicine, 1996; 72 (3): 176–181.

6. Lynn W., Lightman S. Syphilis and HIV: a dangerous combination. The Lancet Infectious Diseases, 2004; 4 (7): 456–466.

7. Dumaresq J., Langevin S., Gagnon S., Serhir B., Deligne B., Tremblay C., Tsang R.S., Fortin C., Coutlée F., Roger M. Clinical prediction and diagnosis of neurosyphilis in HIV-infected patients with early syphilis. Journal of Clinical Microbiology, 2013; 51 (12): 4060–4066.

8. Taylor M.M., Aynalem G., Olea L.M., He P., Smith L.V., Kerndt P.R. A consequence of the syphilis epidemic among men who have sex with men (MSM): neurosyphilis in Los Angeles, 2001–2004. Sexually Transmitted Diseases, 2008; 35 (5): 430–434.

9. Geusau A., Kittler H., Hein U., Dangl-Erlach E., Stingl G., Tschachler E. Biological false positive tests comprise a high proportion of Venereal Disease Research Laboratory reactions in an analysis of 300,000 sera. International Journal of STD & AIDS, 2005; 16 (11): 722–726.

10. Augenbraun M., Rolfs R., Johnson R., Joesoef R., Pope V. Treponemal specific tests for the serodiagnosis of syphilis. Sexually Transmitted Diseases, 1998; 25 (10): 549–552.

11. Rompalo A.M., Cannon R.O., Quinn T.C., Hook E.W. 3rd. Association of biologic false-positive reactions for syphilis with human immunodeficiency virus infection. The Journal of Infectious Diseases, 1992; 165 (6): 1124–1126.

12. Jurado R.L., Campbell J., Martin P.D. Prozone phenomenon in secondary syphilis. Has its time arrived? The Archives of Internal Medicine, 1993; 153 (21): 2496–2498.

13. Gourevitch M.N., Selwyn P.A., Davenny K., Buono D., Schoenbaum E.E., Klein R.S., Friedland G.H. Effects of HIV infection on the serologic manifestations and response to treatment of syphilis in intravenous drug users. Annals of Internal Medicine, 1993; 118 (5): 350–355.

14. Augenbraun M.H., DeHovitz J.A., Feldman J., Clarke L., Landesman S., Minkoff H.M. Biological false positive syphilis test results for women infected with human immunodeficiency virus. Clinical Infectious Diseases, 1994; 19 (6): 1040–1044.

15. Rusnak J.M., Butzin C., McGlasson D., Blatt S.P. False positive rapid plasma reagin tests in human immunodeficiency virus infection and relationship to anti-cardiolipin antibody and serum immunoglobulin levels. The Journal of Infectious Diseases, 1994; 169 (6): 1356–1359.

16. Федеральные клинические рекомендации по ведению больных сифилисом. М., 2015. 45 c.

17. Zetola N.M., Klausner J.D. Syphilis and HIV infection: an update. Clinical Infectious Diseases, 2007; 44 (9): 1222–1228.

18. Workowski K.A., Bolan G.A.; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Morbidity and Mortality Weekly Report, 2015; 64 (3): 34–51.

19. Janier M., Hegyi V., Dupin N., Unemo M., Tiplica G.S., Potočnik M., French P., Patel R. European guideline on the management of syphilis. Journal of the European Academy of Dermatology and Venereology, 2014; 28 (12): 1581–1593.

20. Tramont E.C. Treponema pallidum (Syphilis). In: Mandell G.L., Bennett J.E., Dolin R. (eds). Principles and Practice of Infectious Diseases (7th ed). Churchill Livingstone: Philadelphia, PA., 2009; pp. 3035–3053.

21. Sparling P.F., Swartz M.N., Musher D.M., Healy B.P. Clinical Manifestations of Syphilis. In: Holmes K.K., Sparling P.F., Stamm W.E., Piot P., Wasserheit J., Corey L., Cohen M.S., Watts D.H. (eds). Sexually Transmitted Diseases (4th ed). McGraw Medical: New York City, NY., 2008;HIV Infection and Immunosuppressive Disorders, 2018, Vol. 10, No. 2 52

22. STD Surveillance Case Definitions. In: Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2012. U.S. Department of Health and Human Services: Atlanta, Georgia, 2014; pp. 140–147.

23. Sparling P.F. Diagnosis of Neurosyphilis: New Tools. Sexually Transmitted Diseases, 2010; 37 (5): 288–289.

24. Tuddenham S., Ghanem K.G. Neurosyphilis: knowledge gaps and controversies. Sexually Transmitted Diseases, 2018; 45 (3): 147–151.

25. Chan D.J. Syphilis and HIV: when is lumbar puncture indicated? Current HIV Research, 2005; 3 (1): 95–98.

26. Singh A.E., Romanowski B. Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. Clinical Microbiology Reviews, 1999; 12 (2): 187–209.

27. Marshall D.W., Brey R.L., Cahill W.T., Houk R.W., Zajac R.A., Boswell R.N. Spectrum of cerebrospinal fluid findings in various stages of human immunodeficiency virus infection. Archives of Neurology, 1988; 45 (9): 954–958.

28. Marra C.M., Maxwell C.L., Smith S.L., Lukehart S.A., Rompalo A.M., Eaton M., Stoner B.P., Augenbraun M., Barker D.E., Corbett J.J., Zajackowski M., Raines C., Nerad J., Kee R., Barnett S.H. Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features. The Journal of Infectious Diseases, 2004; 189 (3): 369–376.

29. Marra C.M., Maxwell C.L., Collier A.C., Robertson K.R., Imrie A. Interpreting cerebrospinal fluid pleocytosis in HIV in the era of potent antiretroviral therapy. BMC Infectious Diseases, 2007; 7: 37.

30. Castro R., Prieto E.S., da Luz Martins Pereira F. Nontreponemal tests in the diagnosis of neurosyphilis: an evaluation of the Venereal Disease Research Laboratory (VDRL) and the Rapid Plasma Reagin (RPR) tests. Journal of Clinical Laboratory Analysis, 2008; 22 (4): 257–261.

31. Zhu L., Gu X., Peng R.R., Wang C., Gao Z., Zhou P., Gao Y., Shi M., Guan Z., Seña A.C. Comparison of the cerebrospinal fluid (CSF) toluidine red unheated serum test and the CSF rapid plasma reagin test with the CSF venereal disease research laboratory test for diagnosis of neurosyphilis among HIV-negative syphilis patients in China. Journal of Clinical Microbiology, 2014; 52 (3): 736–740.

32. Marra C.M., Tantalo L.C., Maxwell C.L., Ho E.L., Sahi S.K., Jones T. The rapid plasma reagin test cannot replace the venereal disease research laboratory test for neurosyphilis diagnosis. Sexually transmitted diseases, 2012; 39 (6): 453–457.

33. Eaton M. Syphilis and HIV: old and new foes aligned against us. Current Infectious Disease Reports, 2009; 11 (2): 157–162.

34. Hart G. Syphilis tests in diagnostic and therapeutic decision making. Annals of Internal Medicine, 1986; 104 (3): 368–376.

35. Prange H.W., Moskophidis M., Schipper H.I., Müller F. Relationship between neurological features and intrathecal synthesis of IgG antibodies to Treponema pallidum in untreated and treated human neurosyphilis. Journal of Neurology, 1983; 230 (4): 241–252.

36. MacLean S., Luger A. Finding neurosyphilis without the Venereal Disease Research Laboratory Test. Sexually Transmitted Diseases, 1996; 23 (5): 392–394.

37. Davis L.E., Schmitt J.W. Clinical significance of cerebrospinal fluid tests for neurosyphilis. Annals of Neurology, 1989; 25 (1): 50–55.

38. van Eijk R.V.W., Wolters E.Ch., Tutuarima J.A., Hische E.A., Bos J.D., van Trotsenburg L., de Koning G.A., van der Helm H.J. Effect of early and late syphilis on central nervous system: cerebrospinal fluid changes and neurological deficit. Genitourinary Medicine, 1987; 63 (2): 77–82.

39. Ghanem K.G., Moore R.D., Rompalo A.M., Erbelding E.J., Zenilman J.M., Gebo K.A. Neurosyphilis in a clinical cohort of HIV-1-infected patients. AIDS, 2008; 22 (10): 1145–1151.

40. Marra C.M., Tantalo L.C., Maxwell C.L., Dougherty K., Wood B. Alternative cerebrospinal fluid tests to diagnose neurosyphilis in HIV-infected individuals. Neurology, 2004; 63 (1): 85–88.

41. Libois A., De Wit S., Poll B., Garcia F., Florence E., Del Rio A., Sanchez P., Negredo E., Vandenbruaene M., Gatell J.M., Clumeck N. HIV and syphilis: when to perform a lumbar puncture. Sexually Transmitted Diseases, 2007; 34 (3): 141–144.

42. Wang Y.J., Chi C.Y., Chou C.H., Ho C.M., Lin P.C., Liao C.H., Ho M.W., Wang J.H. Syphilis and neurosyphilis in human immunodeficiency virus-infected patients: a retrospective study at a teaching hospital in Taiwan. Journal of Microbiology, Immunology and Infection, 2012; 45 (5): 337–342.

43. Marra C.M. Neurosyphilis. In: Scheld W.M., Whitley R.J., Marra C.M. (eds) Infectious Diseases of central Nervous System. Wolters Kluwer Health: Philadelphia, PA, 2014; chapter 38.

44. Wang C., Wu K., Yu Q., Zhang S., Gao Z., Liu Y., Ni L., Cheng Y., Guan Z., Shi M., Lu H., Lou Y., Zhou P. CXCL13, CXCL10 and CXCL8 as potential biomarkers for the diagnosis of neurosyphilis patients. Scientific Reports, 2016; 6: 33569.

45. Rolfs R.T., Joesoef M.R., Hendershot E.F., Rompalo A.M., Augenbraun M.H., Chiu M., Bolan G., Johnson S.C., French P., Steen E., Radolf J.D., Larsen S. A randomized trial of enhanced therapy for early syphilis in patients with and without human immunodeficiency virus infection. The Syphilis and HIV Study Group. The New England Journal of Medicine, 1997; 337 (5): 307–314.

46. Manavi K., McMillan A. The outcome of treatment of early latent syphilis and syphilis with undetermined duration in HIV-infected and HIV-uninfected patients. International Journal of STD & AIDS, 2007; 18 (12): 814–818.

47. Jinno S., Anker B., Kaur P., Bristow C.C., Klausner J.D. Predictors of serological failure after treatment in HIV-infected patients with early syphilis in the emerging era of universal antiretroviral therapy use. BMC Infectious Diseases, 2013; 13: 605.ВИЧинфекция и иммуносупрессии, 2018 г., Том 10, № 2 53

48. Yang C.J., Lee N.Y., Chen T.C., Lin Y.H., Liang S.H., Lu P.L., Huang W.C., Tang H.J., Lee C.H., Lin H.H., Chen Y.H., Ko W.C., Hung C.C. One dose versus three weekly doses of benzathine penicillin G for patients co-infected with HIV and early syphilis: a multicenter, prospective observational study. PLoS One, 2014; 9 (10): e109667.

49. Berry C.D., Hooton T.M., Collier A.C., Lukehart S.A. Neurologic relapse after benzathine penicillin therapy for secondary syphilis in a patient with HIV infection. The New England Journal of Medicine, 1987; 316 (25): 1587–1589.

50. Walter T., Lebouche B., Miailhes P., Cotte L., Roure C., Schlienger I., Trepo C. Symptomatic relapse of neurologic syphilis after benzathine penicillin G therapy for primary or secondary syphilis in HIV-infected patients. Clinical Infectious Diseases, 2006; 43 (6): 787–790.

51. Malone J.L., Wallace M.R., Hendrick B.B., LaRocco A. Jr., Tonon E., Brodine S.K., Bowler W.A., Lavin B.S., Hawkins R.E., Oldfield E.C. 3rd. Syphilis and neurosyphilis in a human immunodeficiency virus type-1 seropositive population: evidence for frequent serologic relapse after therapy. The American Journal of Medicine, 1995; 99 (1): 55–63.

52. Marra C.M., Boutin P., McArthur J.C., Hurwitz S., Simpson P.A., Haslett J.A., van der Horst C., Nevin T., Hook E.W. 3rd. A pilot study evaluating ceftriaxone and penicillin G as treatment agents for neurosyphilis in human immunodeficiency virus-infected individuals. Clinical Infectious Diseases, 2000; 30 (3): 540–544.

53. Yinnon A.M., Coury-Doniger P., Polito R., Reichman R.C. Serologic response to treatment of syphilis in patients with HIV infection. Archives of Internal Medicine, 1996; 156 (3): 321–325.

54. Seña A.C., Zhang X.H., Li T., Zheng H.P., Yang B., Yang L.G., Salazar J.C., Cohen M.S., Moody M.A., Radolf J.D., Tucker J.D. A systematic review of syphilis serological treatment outcomes in HIV-infected and HIV-uninfected persons: rethinking the significance of serological non-responsiveness and the serofast state after therapy. BMC Infectious Diseases, 2015; 15: 479.

55. Ghanem K.G., Erbelding E.J., Wiener Z.S., Rompalo A.M. Serological response to syphilis treatment in HIV-positive and HIV-negative patients attending sexually transmitted diseases clinics. Sexually Transmitted Infections, 2007; 83 (2): 97–101.

56. Kofoed K., Gerstoft J., Mathiesen L.R., Benfield T. Syphilis and human immunodeficiency virus (HIV)-1 coinfection: influence on CD4 T-cell count, HIV-1 viral load, and treatment response. Sexually Transmitted Diseases, 2006; 33 (3): 143–148.

57. Blank L.J., Rompalo A.M., Erbelding E.J., Zenilman J.M., Ghanem K.G. Treatment of syphilis in HIV-infected subjects: a systematic review of the literature. Sexually Transmitted Infections, 2011; 87 (1): 9–16.

58. Ghanem K.G., Moore R.D., Rompalo A.M., Erbelding E.J., Zenilman J.M., Gebo K.A. Antiretroviral therapy is associated with reduced serologic failure rates for syphilis among HIV-infected patients. Clinical Infectious Diseases, 2008; 47 (2): 258–265.

59. Marra C.M., Maxwell C.L., Tantalo L.C., Sahi S.K., Lukehart S.A. Normalization of serum rapid plasma reagin titer predicts normalization of cerebrospinal fluid and clinical abnormalities after treatment of neurosyphilis. Clinical Infectious Diseases, 2008; 47 (7): 893–899.

60. Ghanem K.G., Moore R.D., Rompalo A.M., Erbelding E.J., Zenilman J.M., Gebo K.A. Lumbar puncture in HIV-infected patients with syphilis and no neurologic symptoms. Clinical Infectious Diseases, 2009; 48 (6): 816–821.

61. Marra C.M., Maxwell C.L., Tantalo L., Eaton M., Rompalo A.M., Raines C., Stoner B.P., Corbett J.J., Augenbraun M., Zajackowski M., Kee R., Lukehart S.A. Normalization of cerebrospinal fluid abnormalities after neurosyphilis therapy: does HIV status matter? Clinical Infectious Diseases, 2004; 38: 1001–1006.

62. Gordon S.M., Eaton M.E., George R., Larsen S., Lukehart S.A., Kuypers J., Marra C.M., Thompson S. The response of symptomatic neurosyphilis to high-dose intravenous penicillin G in patients with human immunodeficiency virus infection. The New England Journal of Medicine, 1994; 331 (22): 1469–1473.

63. Marra C.M., Longstreth W.T. Jr., Maxwell C.L., Lukehart S.A. Resolution of serum and cerebrospinal fluid abnormalities after treatment of neurosyphilis: influence of concomitant human immunodeficiency virus infection. Sexually Transmitted Diseases, 1996; 23 (3): 184–189.


Для цитирования:


Красносельских Т.В., Манашева Е.Б., Гезей М.А. ПРОБЛЕМЫ ДИАГНОСТИКИ И ЛЕЧЕНИЯ СИФИЛИСА ПРИ КОИНФЕКЦИИ ВИРУСОМ ИММУНОДЕФИЦИТА ЧЕЛОВЕКА. ВИЧ-инфекция и иммуносупрессии. 2018;10(2):43-53. https://doi.org/10.22328/2077-9828-2018-10-2-43-53

For citation:


Krasnoselskikh T.V., Manasheva E.B., Gezei M.A. DIAGNOSIS AND TREATMENT OF SYPHILIS IN PATIENTS COINFECTED WITH HUMAN IMMUNODEFICIENCY. HIV Infection and Immunosuppressive Disorders. 2018;10(2):43-53. (In Russ.) https://doi.org/10.22328/2077-9828-2018-10-2-43-53

Просмотров: 77


Creative Commons License
Контент доступен под лицензией Creative Commons Attribution 4.0 License.


ISSN 2077-9828 (Print)