NEUROSYPHILIS IN HIV-INFECTED PATIENTS

To determine the prevalence and the clinical and serological findings of neurosyphilis in HIV-infected patients, Treponema pallidum hemagglu tination (TPHA) tests, CD4+ lymphocyte counts and determination of rap id plasma reagin (RPR) titers were performed in 972 HIV-infected patie nts over a period of 3.5 years. Patients were scored according to the Centers for Disease Control's classification for HIV infection. Reacti ve serum syphilis tests and positive cerebrospinal fluid (CSF)-Venerea l Disease Research Laboratory (VDRL) tests, with or without clinical s ymptoms, 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 t o HIV infection in 6 patients and after HIV infection in 6 patients. C SF examinations were performed in 28 of the 31 (90.3 %) patients with serologically evident syphilis. Four patients had positive CSF-VDRL te sts with pleocytosis (23.5 % of untreated syphilis patients in whom CS F was examined), three of whom reported mild headache, which was consi dered a doubtful manifestation of neurosyphilis. Patients with syphili s diagnosed and treated prior to diagnosis of HIV infection did not ha ve evidence of neurosyphilis. Seven patients had pleocytosis with a ne gative CSF-VDRL test, without any clinical manifestations of neurosyph ilis. There was no significant difference in the mean CD4+ lymphocyte count between patients with and without neurosyphilis (p = 0.5). RPR t iters in neurosyphilis patients were greater than those in patients pr eviously 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-VD RL tests with a lower level of pleocytosis. The prevalence of neurosyp hilis was 0.4 % in HIV-infected patients and 23.5 % in HIV-infected pa tients with untreated syphilis. This high prevalence of neurosyphilis warrants CSF examination in HIV-infected patients with syphilis, regar dless of the stage of syhilis.