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Jarisch-Herxheimer reaction among HIV-positive patients with early syphilis: azithromycin versus benzathine penicillin G therapy
- Source :
- Journal of the International AIDS Society
- Publication Year :
- 2013
-
Abstract
- Introduction : The Jarisch-Herxheimer reaction, a febrile inflammatory reaction that often occurs after the first dose of chemotherapy in spirochetal diseases, may result in deleterious effects to patients with neurosyphilis and to pregnant women. A single 2-g oral dose of azithromycin is an alternative treatment to benzathine penicillin G for early syphilis in areas with low macrolide resistance. With its potential anti-inflammatory activity, the impact of azithromycin on the incidence of the Jarisch-Herxheimer reaction in HIV-positive patients with early syphilis has rarely been investigated. Methods : In HIV-positive patients with early syphilis, the Jarisch-Herxheimer reaction was prospectively investigated using the same data collection form in 119 patients who received benzathine penicillin G between 2007 and 2009 and 198 who received azithromycin between 2012 and 2013, when shortage of benzathine penicillin G occurred in Taiwan. Between 2012 and 2013, polymerase chain reaction (PCR) assay was performed to detect Treponema pallidum DNA in clinical specimens, and PCR restriction fragment length polymorphism of the 23S ribosomal RNA was performed to detect point mutations (2058G or A2059G) that are associated with macrolide resistance. Results : The overall incidence of the Jarisch-Herxheimer reaction was significantly lower in patients receiving azithromycin than those receiving benzathine penicillin G (14.1% vs. 56.3%, p< 0.001). The risk increased with higher rapid plasma reagin (RPR) titres (adjusted odds ratio [AOR] per 1-log 2 increase, 1.21; confidence interval [CI], 1.04–1.41), but decreased with prior penicillin therapy for syphilis (AOR, 0.37; 95% CI, 0.19–0.71) and azithromycin treatment (AOR, 0.15; 95% CI, 0.08–0.29). During the study period, 310 specimens were obtained from 198 patients with syphilis for PCR assays, from whom T. pallidum was identified in 76 patients, one of whom (1.3%) was found to be infected with T. pallidum harbouring the macrolide resistance mutation (A2058G). In subgroup analyses confined to the 75 patients infected with T. pallidum lacking resistance mutation, a statistically significantly lower risk for the Jarisch-Herxheimer reaction following azithromycin treatment was noted. Conclusions : Treatment with azithromycin was associated with a lower risk for the Jarisch-Herxheimer reaction than that with benzathine penicillin G in HIV-positive patients with early syphilis. Previous benzathine penicillin G therapy for syphilis decreased the risk, whereas higher RPR titres increased the risk, for the reaction. Keywords: sexually transmitted diseases; spirochetal disease; macrolides; macrolide resistance; immunomodulation. (Published: 28 August 2014) Citation: Tsai M-S et al. Journal of the International AIDS Society 2014, 17 :18993 http://www.jiasociety.org/index.php/jias/article/view/18993 | http://dx.doi.org/10.7448/IAS.17.1.18993
- Subjects :
- Adult
DNA, Bacterial
Male
medicine.medical_specialty
Drug-Related Side Effects and Adverse Reactions
Fever
sexually transmitted diseases
macrolide resistance
Penicillin G Benzathine
Taiwan
HIV Infections
Microbial Sensitivity Tests
Azithromycin
Lower risk
immunomodulation
Gastroenterology
DNA, Ribosomal
Polymerase Chain Reaction
Rapid plasma reagin
Neurosyphilis
Cohort Studies
Internal medicine
medicine
Humans
Prospective Studies
Syphilis
Treponema pallidum
medicine.diagnostic_test
business.industry
macrolides
Incidence
Public Health, Environmental and Occupational Health
Jarisch–Herxheimer reaction
medicine.disease
Anti-Bacterial Agents
Penicillin
RNA, Ribosomal, 23S
Infectious Diseases
spirochetal disease
Immunology
Female
business
Polymorphism, Restriction Fragment Length
medicine.drug
Research Article
Subjects
Details
- ISSN :
- 17582652
- Volume :
- 17
- Database :
- OpenAIRE
- Journal :
- Journal of the International AIDS Society
- Accession number :
- edsair.doi.dedup.....9078493f6a46ab18be2375b82eba3d27