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Neurosyphilis in HIV-Infected Patients: Clinical Manifestations, Serum Venereal Disease Research Laboratory Titers, and Associated Factors to Symptomatic Neurosyphilis

Poliseli, Rodolfo MD*; Vidal, Jose E. MD, PhD†‡; Penalva De Oliveira, Augusto C. MD, PhD†§; Hernandez, Adrian V. MD, PhD

Sexually Transmitted Diseases: May 2008 - Volume 35 - Issue 5 - p 425-429
doi: 10.1097/OLQ.0b013e3181623853

Goal: To describe clinical and laboratory features of human immunodeficiency infection (HIV)-infected patients with neurosyphilis.

Study Design: Retrospective study of 27 consecutive cases of HIV-infected patients with a positive Venereal Disease Research Laboratory (VDRL) in cerebrospinal fluid (CSF).

Results: Median of age was 36 years and 89% were men. Ten (37%) patients had previous nonneurologic syphilis treatment. At the time of neurosyphilis diagnosis, 10 (37%) patients had early syphilis, and 6 of them were neurologically asymptomatic. Nine (33%) patients had symptomatic neurosyphilis. Twenty-six (96%) patients were classified with early neurosyphilis. The medians of serum VDRL and CD4+ T cell counts were 1:128 and 182 cell/μL, respectively. Twenty five (93%) patients presented serum VDRL titers ≥1:16. Five of 6 patients with early syphilis and asymptomatic neurosyphilis, presented serum VDRL ≥1:16. Symptomatic patients showed lower CD4+ T cell counts (59 cell/μL vs. 208 cell/μL, P = 0.03) and higher protein concentration on CSF (118 mg/dL vs. 39 mg/dL, P <0.001) than asymptomatic patients.

Conclusions: Most patients had early and asymptomatic neurosyphilis, and more than one third had early syphilis. Patients with symptomatic neurosyphilis showed lower CD4+ T cell counts and higher protein concentration on CSF than those asymptomatic. Most patients had serum VDRL titers ≥1:16, regardless of syphilis stage.

A retrospective study of 27 HIV-infected patients with neurosyphilis (positive CSF VDRL) found that 25 (93%) of them presented serum VDRL titers ≥ 1:16, regardless of syphilis stage.

From the Departments of *Infectious Diseases, and †Neurology, Emíılio Ribas Institute of Infectious Diseases, Sao Paulo, Brazil; ‡AIDS Clinic, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil; §Clinical Research Unit in Human Retrovirology, University of Campinas, Sao Paulo, Brazil; and ∥Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio

The authors thank David Clifford, Department of Neurology, University of Washington, St. Louis, for helpful advice and discussion.

Correspondence: José E. Vidal, MD, PhD, AIDS Clinic, Hospital das Clinicas, University of Sao Paulo School of Medicine, Rua Frei Caneca 557, 01307-001, Sao Paulo, Brazil. E-mail:

Received for publication August 13, 2007, and accepted November 13, 2007.

© Copyright 2008 American Sexually Transmitted Diseases Association