Reduced Treponema pallidum–Specific Opsonic Antibody Activity in HIV-Infected Patients With Syphilis

Background. Human immunodeficiency virus (HIV)–infected individuals may have poorer serological responses to syphilis treatment and may be more likely to experience neurosyphilis. Treponema pallidum is cleared from sites of infection by opsonization, ingestion, and killing by macrophages. Methods. Serum samples from 235 individuals with syphilis were tested for T. pallidum–specific opsonic activity. Blood T. pallidum concentrations were determined by real-time polymerase chain reaction amplification of the tp0574 gene, and T. pallidum was detected in cerebrospinal fluid (CSF) by reverse-transcriptase polymerase chain reaction of 16S ribosomal RNA. Results. Opsonic activity was higher with higher serum rapid plasma reagin titers (P < .001), and in those treated for uncomplicated syphilis before serum collection (P < .001). Opsonic activity was lower in HIV-infected than in HIV-uninfected individuals even after the above factors were taken into account (P = .006). In participants in whom blood T. pallidum was detectable, those with the highest opsonic activity had lower blood T. pallidum concentrations. In multivariable analyses, there was not a significant relationship between opsonic activity and detection of T. pallidum in CSF or CSF-VDRL reactivity. Conclusions. Serum T. pallidum–specific opsonic activity is significantly lower in HIV-infected individuals. Impaired T. pallidum–specific immune responses could contribute to differences in the course of disease or treatment response.