Acute Syphilitic Meningitis in a Man With Seropositivity for Human Immunodeficiency Virus Infection and Normal Numbers of CD4 T Lymphocytes

DiNubile, Mark J.; Baxter, John D.; Mirsen, Thomas R.

doi:10.1001/archinte.1992.00400180162028

Cited by 5 publications

(1 citation statement)

References 37 publications

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“…33 The long-term effects of untreated syphilis during HIV infection are unknown, but patients with HIV may develop severe syphilitic lesions and more often develop neurosyphilis. 36,37 (b) Treatment of early syphilis did not lead to CD4 T cell recovery in all cases. Five patients receiving ART developed resistance that required changes in ART, whilst a significant CD4 T cell reduction in six untreated patients led to initiation of ART.…”

Section: Discussionmentioning

confidence: 92%

Early syphilis affects markers of HIV infection

et al. 2016

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The objective of this study was to investigate if early syphilis infection affects markers of HIV infection; CD4 T cells and viral load (VL). A retrospective study was performed on 160 HIV-positive patients (111 receiving antiretroviral therapy [ART] and 49 without ART). Early syphilis diagnosis was made in HIV patients during their follow-up at the HIV/AIDS Unit at a Greek Dermatology and Venereology Unit. The patients' blood tests were available at the time of diagnosis, as well as before and 12 weeks after early syphilis diagnosis. CD4 T cell counts and VL levels were measured. It was found that syphilis infection had a negative impact on the CD4 T cell counts in both groups, with reduced CD4 T cell counts observed in 84.6% (99/111) and 79.5% (39/49) of patients receiving and not receiving ART, respectively. After treatment for syphilis, CD4 T cell counts returned to pre-treatment levels in most patients, especially those receiving ART. There was a slight and transient VL increase. Patients receiving ART had a 27% increase in VL, compared to 71.4% among patients not receiving ART. Although the VL increase was slight (41-14,000 copies/ml) in the group under treatment, 4-5% (5/111) patients did not return to pre-treatment levels. Moreover, viral mutations associated with treatment resistance were identified in these patients. Early syphilis accelerates and complicates the progression of HIV infection. Early diagnosis and treatment of syphilis may prevent infection-associated complications in most instances. Consequently, prevention of syphilis and other sexually transmitted infections is of great importance for patients infected with HIV.

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Section: Discussionmentioning

confidence: 92%

Early syphilis affects markers of HIV infection

et al. 2016

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CD8 T Cells in Human Immunodeficiency Virus Infection

Stricker¹

1993

Arch Intern Med

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In their excellent article on syphilitic meningitis in a human immunodeficiency virus-positive patient, DiNubile et al1 focus on the patient's CD4 T-cell count of 1070 cells per cubic millimeter. According to the numbers in the article, the patient's CD8 T-cell count was approximately 4130 cells per cubic millimeter.The authors spend the bulk of the report discussing the implications of a normal CD4 T-cell count in this setting. It seems ironic that the authors (like most of the medical establishment) are so fixated on CD4 T cells that they can ignore a CD8 T-cell count four times higher than normal in their patient. I would like to hear more about the implications of significantly increased CD8 T cells in neurosyphilis, since the role of these cells in human immunodeficiency virus disease may be quite important.2,3We read with interest the recent article entitled "A Possible Protective Effect of Nut Consumption on Risk of Coronary Heart Disease"1 and the accompanying editorial2 in the July 1992 issue of the Archives. The results of the study showed a substantial protective effect of high nut consumption on fatal and nonfatal coronary heart disease events. A reduction in the incidence of nonfatal myocardial infarction for those who consumed only whole-wheat bread was also documented. The authors' explanation of the results centered around the unique fat and fiber content of nuts and the controversial role of vitamin E. We believe that magne-sium may be an alternative explanation to the purported protective effect of the consumption of nuts on coronary heart disease.A number of studies have documented an inverse relationship between magnesium intake and the risk of coronary heart disease. For example, several large population studies have shown an inverse correlation between the concentration of magnesium in the drinking water and the prevalence of death by ischémie heart dis¬ ease.34 The most recent accepted recommended dietary allowance for adults of both sexes is 4.5 mg of magne¬ sium per kilogram per day, or about 300 mg/d.3 This is the amount of magnesium needed to circumvent overt signs of deficiency. Optimal magnesium intake, to avoid more subtle chronic conditions such as developing cor¬ onary heart disease, may require more magnesium. Stud¬ ies now estimate that up to 75% of the population in the United States has a magnesium intake below the recom¬ mended dietary allowance.6-7 This is due primarily to the progressive increase in consumption of processed foods, since the processing greatly depletes these foods of mag¬ nesium.8 Foods that are particularly high in magnesium are nuts and cereal grains. On the average, a 100-g (ap¬ proximately 3.5-oz) edible portion of nuts would contain approximately 200 mg of magnesium.9 Thus, if an indi¬ vidual consumes 100 g of nuts daily, this would repre¬ sent about two thirds of the recommended dietary allow¬ ance for magnesium. Further, the consumption of whole¬ wheat bread, as mentioned in the study, would improve the magnesium intake for the study group. Thus, we be...

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