Prevalence of hepatitis in early syphilis among an HIV cohort

Abstract

To investigate the prevalence of syphilitic hepatitis among a group of HIV-infected patients we performed a cross-sectional observational study of consecutive HIV-infected patients with early syphilis attending University Hospital Birmingham between 1 January 2005 and 31 August 2008. The AIDS Clinical Trials Group grading for abnormal liver enzymes was used to identify hepatitis. A total of 62 HIV-infected patients were diagnosed with early syphilis during the study period. Twelve (19.3%) of them demonstrated abnormal liver enzymes consistent with syphilitic hepatitis involving raised levels of alanine aminotransferase, aspartate transaminase, alkaline phosphatase or gamma-glutamyl transferase (GGT). Grade 3 hepatotoxicity was observed among five patients. None of the patients with syphilitic hepatitis had grade IV hepatitis or abnormal bilirubin levels. Liver biopsy was not carried out in any of the patients, and following completion of treatment of syphilis all abnormal liver enzymes returned to normal levels after a median of 16 weeks. Exclusion of syphilis must be considered when investigating hepatic disease in HIV-infected patients.

The Great Pretender: early syphilis mimicking acute sclerosing cholangitis

“…In two retrospective studies involving 62 and 147 patients respectively, the incidence of hepatic involvement in HIV-infected patients with early syphilis was recorded as between 19.3% and 30.6% 14 15. Men who have sex with men are a high-risk group for both syphilis and HIV infection 1 2…”

“…The most commonly reported presenting feature of syphilitic hepatitis in HIV-infected patients is rash5 14; pharyngitis and lymphadenopathy are also well described 5. This is in contrast to the historical presentation of abdominal pain, fever, hepatomegaly and liver tenderness 7.…”

The Great Impostor: Transaminitis Masking the Coinfection of Syphilis and Human Immunodeficiency Virus

“…Laboratory parameters include liver enzymes greater than or equal to 1.25 times the upper limit of normal within a 90-day period prior to the diagnosis, the absence of an alternative cause of hepatitis, and resolution of abnormal labs after the treatment of syphilis [9]. Studies show that there is disproportionate elevation in ALP as compared to AST and ALT.…”

Liver and Bile Duct Infections

“…Among HIV-positive patients with syphilis, the rate of liver involvement (based on abnormal liver function tests [LFTs]) is between 19% and 38%. [298][299][300][301] However, others have argued that the true rate of syphilitic hepatitis in this patient population is substantially lower, given that many other etiologies may cause liver dysfunction in HIV-positive patients, including viral hepatitis, drug hepatotoxicity, and fatty liver disease. 302 Liver involvement by syphilis is also common among MSM, [303][304][305][306][307][308][309] possibly from portal transport of the organism after anal intercourse, 309 although this may be confounded by high rates of MSM among HIV-positive patients.…”

“…302 Liver involvement by syphilis is also common among MSM, [303][304][305][306][307][308][309] possibly from portal transport of the organism after anal intercourse, 309 although this may be confounded by high rates of MSM among HIV-positive patients. [299][300][301][302][303][304] A characteristic clinical picture is cholestatic jaundice, hepatomegaly, and a disproportionately elevated alkaline phosphatase level. 305,307,308,[310][311][312][313] The trademark palmar rash of syphilis may be the key to diagnosis.…”