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Syphilis serology in human immunodeficiency virus infection: evidence for false-negative fluorescent treponemal testing.
Erbelding EJ; Vlahov D; Nelson KE; Rompalo AM; Cohn S; Sanchez P; Quinn
January 30, 1998
J Infect Dis. 1997 Nov;176(5):1397-400. Unique Identifier : AIDSLINE

Injection drug users were assessed serologically for human immunodeficiency virus infection and syphilis every 6 months. Treatment histories were reviewed for any high-titer biologic false-positive (BFP) reactors, that is, persons with rapid plasma reagin (RPR) titers > or = 1:4 and negative results for fluorescent treponemal antibody absorption (FTA-ABS) tests. Selected sera were analyzed further by immunoblotting for the presence of antibodies reactive with specific Treponema pallidum antigens. Of 112 BFP reactors, 35 (31%) had at least one RPR test reactive at a dilution >1:8 while the FTA-ABS test remained nonreactive. Five reactors (4.5%) converted from nonreactive to reactive by FTA-ABS test; 4 (3.6%) were reactive by FTA-ABS tests but later became nonreactive. Antibodies to T. pallidum membrane antigens were detected in some samples that were persistently nonreactive by FTA-ABS test. Serologic patterns over time, along with very high-titer BFP reactions and reactivity with T. pallidum-specific antigens, suggest that some BFP reactions may represent FTA-negative syphilis.

*Antibodies, Bacterial/BLOOD *HIV Infections/IMMUNOLOGY *Substance Abuse, Intravenous/COMPLICATIONS *Syphilis/DIAGNOSIS *Treponema pallidum/IMMUNOLOGY