Because of the immunologic dysfunction of HIV-infected patients, concomitant infection with T. pallidum requires that maximal doses of appropriate antibiotics be given, and the expected falls in nontreponemal antibody titer cannot be relied upon to certify a cure. Genital ulcer disease appears to increase the risk of acquiring HIV. Therefore, all HIV-infected persons and persons with syphilis should be tested for both syphilis and HIV.
There has been a dramatic improvement in the ability to diagnose P. carinii pneumonia since the beginning of the AIDS epidemic. Currently at the NIH over 90% of patients with P. carinii pneumonia can be diagnosed within a few hours of presentation by examination of an induced sputum specimen. Improved diagnosis has led to earlier initiation of therapy and an improvement in survival. However, as clinical management of AIDS patients improves, it is possible that there will be a change in the clinical presentation of P. carinii pneumonia, with an associated increased difficulty in making the correct diagnosis.
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