Potential predictors for serofast state after treatment among HIV-negative persons with syphilis in China: A systematic review and meta-analysis

Background: several studies have been conducted in china in order to investigate the potential predictors of serofast state after treatment among syphilitic patients. however,there is a remarkable diversity among the results. this meta-analysis was conducted to assess potential predictors of serofast among syphilitic patients in china. methods: international and national electronic databases were searched up to september 2013. reference lists of retrieved articles were also reviewed. cohort or case-control studies addressing risk factors of serofast among syphilitic patients were included in this study. results: we assessed 27 separate studies involving overall 6682 hiv-negative participants with syphilis of which 1962 remained in the serofast state. the serofast was positively associated with older age(ptrend=0.001),female(summary risk ratio[srr]=1.50,95%ci:1.34–;1.68),latent syphilis(srrlatent vs primary=3.17,95%ci: 2.66–;3.77; srrlatent vs secondary=2.00,95%ci: 1.48–;2.69) as well as non-penicillin treatment(srr =2.99,95%ci:2.45–;3.67),but negatively associated with higher baseline titers(srr>1:32 vs ≤1:32=0.63,95%ci: 0.54–;0.75). compared with healthy group and serological cure group,respectively,the levels of cd4 (+),il-2,and il-6 among serofast patients were decreased (standardized mean difference[smd]<0,p<0.05),but the levels of cd8(+) and il-10 were increased(smd>0,p<0.05). some studies also hinted the serofast was associated with subtypes i of treponema pallidum(tp) repeat gene (rr i vs d=4.67,95%ci: 1.31–;16.69) and tp occult infection. conclusion: the age,gender,stage of infection,baseline titers,treatment drug,cellular immune suppression and disorders,tp occult infection and subtypes i of tp repeat gene should be considered as important predictors of serofast. however,until now the definition and mechanism of serofast has still been not clear. © 2015,iranian journal of public health. all rights reserved.