Neurosyphilis in HIV-infected patients

Abstract

To determine the prevalence and the clinical and serological findings of neurosyphilis in HIV-infected patients, Treponema pallidum hemagglutination (TPHA) tests, CD4+ lymphocyte counts and determination of rapid plasma reagin (RPR) titers were performed in 972 HIV-infected patients over a period of 3.5 years. Patients were scored according to the Centers for Disease Control's classification for HIV infection. Reactive serum syphilis tests and positive cerebrospinal fluid (CSF)-Venereal Disease Research Laboratory (VDRL) tests, with or without clinical symptoms, were used as the criteria for diagnosis of neurosyphilis. The TPHA test was positive in 31 patients, representing 3.1% of all HIV-infected patients included in the study. Of these, 13 were intravenous drug addicts, 14 were homosexuals and 4 were heterosexuals. Diagnosis of syphilis was concurrent with HIV infection in 19 patients, prior to HIV infection in 6 patients and after HIV infection in 6 patients. CSF examinations were performed in 28 of the 31 (90.3%) patients with serologically evident syphilis. Four patients had positive CSF-VDRL tests with pleocytosis (23.5% of untreated syphilis patients in whom CSF was examined), three of whom reported mild headache, which was considered a doubtful manifestation of neurosyphilis. Patients with syphilis diagnosed and treated prior to diagnosis of HIV infection did not have evidence of neurosyphilis. Seven patients had pleocytosis with a negative CSF-VDRL test, without any clinical manifestations of neurosyphilis. There was no significant difference in the mean CD4+ lymphocyte count between patients with and without neurosyphilis (p = 0.5). RPR titers in neurosyphilis patients were greater than those in patients previously treated for syphilis and in those with pleocytosis only (p = 0.046 and 0.036, respectively). All neurosyphilis patients had an RPR titer > 1:8. After therapy, neurosyphilis patients had negative CSF-VDRL tests with a lower level of pleocytosis. The prevalence of neurosyphilis was 0.4% in HIV-infected patients and 23.5% in HIV-infected patients with untreated syphilis. This high prevalence of neurosyphilis warrants CSF examination in HIV-infected patients with syphilis, regardless of the stage of syphilis.

Experience of Meningovascular Syphilis in Human Immunodeficiency Virus Infected Patient

“…Treatment of syphilis in HIV positive people can be an important means of preventing HIV transmission. The incidence of syphilis among HIV-positive individuals is difficult to estimate, but seroprevalence studies have shown evidence of previous exposure to Treponema pallidum in 3% to 35% of HIV-positive patients 3,4,12) . Concurrent HIV infection may alter the progression of syphilis by increasing the propensity of the disease to progress to neurosyphilis, decreasing the latency period before the onset of neurosyphilis, increasing the severity of the manifestations of neurosyphilis, or rendering standard therapy for primary and secondary syphilis inadequate 13) .…”

“…The frequency of neurosyphilis in the HIV-positive population is probably 3-35% 3) . The number of acquired immune deficiency syndrome (AIDS) patients is on the increase even in Korea, therefore the number of patients with neurosyphilis is also expected to increase.…”

Sífilis e infección por el virus de la inmunodeficiencia humana

“…En los pacientes con VIH, la afección del SNC es más frecuente que en la población sin el VIH 5 . Así, en un estudio español 37 , la prevalencia de neurolúes por determinación del test de serología luética (VDRL, venereal disease research laboratory) en el líquido cefalorraquídeo (LCR) en pacientes VIH con sífilis no tratada fue del 23,5%, y la mayoría de los pacientes presentaba cefalea moderada. Aunque la afección del SNC en los individuos con VIH es con más frecuencia asintomática, la clínica puede ser muy diversa, y puede incluir cefalea, alopecia, meningomielitis, síndromes medulares, goma con manifestaciones focales, alteraciones del comportamiento y deterioro cognitivo 5,37,38 .…”

“…Así, en un estudio español 37 , la prevalencia de neurolúes por determinación del test de serología luética (VDRL, venereal disease research laboratory) en el líquido cefalorraquídeo (LCR) en pacientes VIH con sífilis no tratada fue del 23,5%, y la mayoría de los pacientes presentaba cefalea moderada. Aunque la afección del SNC en los individuos con VIH es con más frecuencia asintomática, la clínica puede ser muy diversa, y puede incluir cefalea, alopecia, meningomielitis, síndromes medulares, goma con manifestaciones focales, alteraciones del comportamiento y deterioro cognitivo 5,37,38 . Se ha indicado también que el VIH acelera y modifica el curso clínico de la neurolúes y que las complicaciones neurológicas son más frecuentes y pueden aparecer con cualquier grado de inmunodepresión 5,39 .…”

Rapidly Progressive Tabes Dorsalis Associated with Selective IgA Deficiency.

“…Its pathogenesis remains unclear, and it was thought to be a disease of the past. However, the spread of HIV infection has led neurosyphilis to becomea problem again, because co-infection with HIVleads syphilis to showan atypical and rapid clinical course, with resistance to the previously recommended treatment (1)(2)(3). Selective IgA deficiency is also uncommon,and its pathogenesis and clinical importance are not well understood.…”