EVALUATION OF NEUROSYPHILIS IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED INDIVIDUALS

The diagnosis of neurosyphilis in patients infected with the human imm unodeficiency virus (HIV) remains problematic. We examined the use of the Treponema pallidum hemagglutination (TPHA) index and quantitative tests of CSF by means of microhemagglutination-T. pallidum for diagnos is of neurosyphilis in 58 HIV-infected persons with latent syphilis wh o had not recently received therapy for syphilis. Five patients (9%) h ad reactive CSF VDRL tests and thus had proven neurosyphilis. For 13 p atients (22%), CSF findings were normal and revealed no evidence of ne urosyphilis. For 40 patients (69%), abnormal CSF findings were charact eristic of neurosyphilis, but their CSF VDRL tests were nonreactive. T wenty-five of the 40 patients with possible neurosyphilis had pleocyto sis and elevated CSF levels of protein and/or IgG. Five (12.5%) of the se 40 patients had positive TPHA indices that indicated intrathecal an titreponemal antibody production, a finding that provided greater supp ort for the diagnosis of active neurosyphilis. With use of the TPHA in dex, patients with CSF abnormalities can be better classified in regar d to their need for therapy for neurosyphilis.