Neurosyphilis in a clinical cohort of HIV-1-infected patients.
Open accessAbstract
OBJECTIVES: To describe the risk factors, clinical presentation, and long-term follow up of patients enrolled in a clinical cohort of HIV-infected patients who were diagnosed and treated for neurosyphilis. METHODS: Comprehensive demographic, clinical, and therapeutic data were collected prospectively on all patients between 1990 and 2006. Patients were diagnosed with neurosyphilis if they had positive syphilis serologies and any of the following: (a) one or more cerebrospinal fluid abnormalities on lumbar puncture [white blood cells >10/microl; protein >50 mg/dl; reactive venereal diseases research laboratory], (b) an otherwise unexplained neurological finding. RESULTS: Of 231 newly diagnosed syphilis cases, 41 neurosyphilis cases met entry criteria (median age 38.6 years, 79.1% male). Risk factors for neurosyphilis included a CD4 cell count of less than 350 cells/ml at the time of syphilis diagnosis (odds ratio: 2.87; 95% confidence interval: 1.18-7.02), a rapid plasma regain titer >1: 128 (2.83; 1.11-7.26), and male sex (2.46; 1.06-5.70). Use of any highly active antiretroviral therapy before syphilis infection reduced the odds of neurosyphilis by 65% (0.35; 0.14-0.91). Sixty-three percent of cases presented with early neurosyphilis and the median time to neurosyphilis diagnosis was 9 months. Symptomatic patients had more cerebrospinal fluid abnormalities on initial lumbar puncture than asymptomatic patients (P = 0.01). Follow-up lumbar puncture within 12 months revealed that only 38% had resolution of all cerebrospinal fluid abnormalities. At 1 year, 38% had persistence of their major symptom despite adequate treatment for neurosyphilis. Twelve of 41 (29%) patients were retreated for syphilis. CONCLUSION: Early neurosyphilis was common in this cohort. Highly active antiretroviral therapy to reverse immunosuppression may help mitigate neurological complications of syphilis.
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Using ART per current HIV guidelines might improve clinical outcomes among persons coinfected with HIV and syphilis.
“Using ART per current HIV guidelines might improve clinical outcomes among persons coinfected with HIV and syphilis”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [624]
Concerns regarding adequate treatment of syphilis among persons with HIV infection might not apply to those with HIV virologic suppression.
“concerns regarding adequate treatment of syphilis among persons with HIV infection might not apply to those with HIV virologic suppression (624,625).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [624]
Limited data indicate that changes in CSF parameters might occur more slowly among persons with HIV infection, especially those with more advanced immunosuppression.
“Limited data indicate that changes in CSF parameters might occur more slowly among persons with HIV infection, especially those with more advanced immunosuppression (588,624).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [624]
People living with HIV on ART have reduced serological failure rates.
“People living with HIVon ART have reduced serological failure rates.143”
From BASHH UK guidelines for the management of syphilis 2024 (2024) · cites this paper as [143]
Cites
Nonparametric Estimation from Incomplete Observations
Kaplan, E. L., & Meier, P. (1992) · Springer series in statistics · doi:10.1007/978-1-4612-4380-9_25 · Cited by 45,232 · see citing works
Nonparametric Estimation from Incomplete Observations
Kaplan, E. L., & Meier, P. (1958) · Journal of the American Statistical Association · doi:10.1080/01621459.1958.10501452 · Cited by 39,158 · see citing works
Longitudinal Data Analysis for Discrete and Continuous Outcomes
Zeger, S. L., & Liang, K. (1986) · Biometrics · doi:10.2307/2531248 · Cited by 7,730 · see citing works
Cox’s regression model for counting processes: A large sample study
Andersen, P. K., & Gill, R. D. (1982) · The Annals of Statistics · doi:10.1214/aos/1176345976 · Cited by 4,419 · see citing works
Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines
Workowski, K., & Berman, S. M. (2007) · Clinical Infectious Diseases · doi:10.1086/511430 · Cited by 1,977 · see citing works
Johns, D. R., Tierney, M. R., & Felsenstein, D. (1987) · New England Journal of Medicine · doi:10.1056/nejm198706183162503 · Cited by 567 · see citing works
Marra, C. M., Maxwell, C. L., Smith, S. L., Lukehart, S. A., Rompalo, A. M., Eaton, M., Stoner, B. P., Augenbraun, M., Barker, D. E., Corbett, J. J., et al. (2004) · The Journal of Infectious Diseases · doi:10.1086/381227 · Cited by 491 · see citing works
Self-citationCase Definitions for Public Health Surveillance
Wharton, M. E., Chorba, T. L., Vogt, R. L., Morse, D. L., & Buehler, J. W. (1990) · PsycEXTRA Dataset · doi:10.1037/e546082006-001 · Cited by 463 · see citing works
Berry, C., Hooton, T. M., Collier, A. C., & Lukehart, S. A. (1987) · New England Journal of Medicine · doi:10.1056/nejm198706183162507 · Cited by 340 · see citing works
Gordon, S. M., Eaton, M. E., George, R., Larsen, S. A., Lukehart, S. A., Kuypers, J. M., Marra, C. M., & Thompson, S. E. (1994) · New England Journal of Medicine · doi:10.1056/nejm199412013312201 · Cited by 186 · see citing works
Ghanem, K. G., Erbelding, E. J., Wiener, Z. S., & Rompalo, A. M. (2007) · Sexually Transmitted Infections · doi:10.1136/sti.2006.021402 · Cited by 177 · see citing works
Self-citationMoore, R. D. (1998) · Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology · doi:10.1097/00042560-199801001-00011 · Cited by 156 · see citing works
Self-citationNeurosyphilis during the AIDS Epidemic, San Francisco, 1985-1992
Flood, J., Weinstock, H., Guroy, M. E., Bayne, L. L., Simon, R. P., & BOLAN, G. A. (1998) · The Journal of Infectious Diseases · doi:10.1086/515245 · Cited by 151 · see citing works
Marra, C. M., Maxwell, C. L., Tantalo, L. C., Eaton, M. E., Rompalo, A. M., Raines, C. P., Stoner, B. P., Corbett, J. J., Augenbraun, M. H., Zajackowski, M., et al. (2004) · Clinical Infectious Diseases · doi:10.1086/382532 · Cited by 143 · see citing works
Self-citationSyphilis, Neurosyphilis, Penicillin, and AIDS
Musher, D. M. (1991) · The Journal of Infectious Diseases · doi:10.1093/infdis/163.6.1201 · Cited by 127 · see citing works
Neurosyphilis in Acquired Immunodeficiency Syndrome
Katz, D. A., & Berger, J. R. (1989) · Archives of Neurology · doi:10.1001/archneur.1989.00520440085024 · Cited by 118 · see citing works
(2007) · PsycEXTRA Dataset · doi:10.1037/e639302007-001 · Cited by 96 · see citing works
Neurosyphilis in Human Immunodeficiency Virus Type 1-Seropositive Individuals
Berger, J. R. (1991) · Archives of Neurology · doi:10.1001/archneur.1991.00530190046014 · Cited by 65 · see citing works
Walter, T., Lebouché, B., Miailhes, P., Cotte, L., Roure, C., Schlienger, I., & TREPO, C. G. (2006) · Clinical Infectious Diseases · doi:10.1086/507099 · Cited by 63 · see citing works
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Sexually Transmitted Infections Treatment Guidelines, 2021
Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr7004a1 · Cited by 2,759 · see citing works
Self-citation2014 European guideline on the management of syphilis
Janier, M., Hegyi, V., Dupin, N., Unemo, M., Tiplica, G. S., Potočnik, M., French, P., & Patel, R. (2014) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.12734 · Cited by 360 · see citing works
BASHH UK guidelines for the management of syphilis 2024
Kingston, M., Apea, V., Evans, C., Fifer, H., Foster, K., Patrick, P., Grant, A., Manns, V., Ramsden, S., Sinka, K., et al. (2024) · International Journal of STD & AIDS · doi:10.1177/09564624241280406 · Cited by 51 · see citing works
- Authors
- Ghanem, K. G., Moore, R. D., Rompalo, A. M., Erbelding, E. J., Zenilman, J. M., & Gebo, K. A.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Ghanem, Khalil G
- Venue
- AIDS
- Published
- 2008-06-19
- Volume
- 22
- Issue
- 10
- Pages
- 1145-1151
- ISSN
- 0269-9370 (ISSN-L)
- PMC
- PMC2553365
- OpenAlex
- W2069132905
- Cited by
- 212
- References
- 19
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 11 · 2023: 12 · 2022: 11 · 2021: 10 · 2020: 9 · 2019: 8 · 2018: 12 · 2017: 12 · 2016: 9 · 2015: 24 · 2014: 12 · 2013: 8 · 2012: 10
- FWCI
- 9.28
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- AIDS (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Johns Hopkins University
- National Institutes of Health (1r01ag026250-01a2)
- National Institute on Alcohol Abuse and Alcoholism (R01AA016893)
- National Institute on Aging (R01 AG026250:)
- National Institute on Drug Abuse (R01-DA11602, U01DA036935, K23 DA00523, K24-DA-00432, R01DA011602, K24DA000432, K23DA000523)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD047395)
- Topics
- Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Life Sciences › Immunology and Microbiology › Virology › HIV Research and Treatment
- Keywords
- neurosyphilis, HIV-1 infection, risk factors, CD4 count, RPR titer, highly active antiretroviral therapy, cerebrospinal fluid abnormalities, long-term follow-up
- MeSH terms
- Adult, Aged, Anti-Bacterial Agents, Female, Humans, Male, Middle Aged, Neurosyphilis, Risk Factors, Cohort Studies, HIV-1, AIDS-Related Opportunistic Infections, CD4 Lymphocyte Count, Retreatment, Antiretroviral Therapy, Highly Active
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