HIV Has No Effect on Early Symptomatic Neurosyphilis and Ocular Syphilis Outcomes, Study Says

Patients with HIV who also have early symptomatic neurosyphilis (NS) or ocular syphilis (OS) are more likely to be younger, be men who have sex with men, or have a history of syphilis compared with patients without HIV who have NS/OS, according to a study published in Infectious Diseases Now.

The study results also suggested NS and OS outcomes are not affected by HIV infection.

Researchers analyzed consecutive cases of early symptomatic NS and OS diagnosed between January 1, 2000, and December 31, 2016 to assess the characteristics of symptomatic NS/OS based on HIV status. The data included all cases from 2 infectious diseases departments at 2 French academic hospitals.

A total of 96 patients (93% men, 49% with HIV) were included, with 47 being diagnosed with HIV. Fifteen (16%) had NS, 67 (69%) had OS, and 14 (14%) had both. Patients with HIV were found to be younger (P = .006), more likely to be men having sex with men (P = .00048) or to have a history of syphilis (P = .01).

Among all 81 patients with OS, 43 (57%) had posterior uveitis. Bilateral involvement was more common in patients with HIV than those without (62% vs 38%, P = .045).

Among all 29 patients with NS, 21 (72%) had cranial nerve involvement with most (76%) of those cases involving the 8th cranial nerve. Additionally, 7 (24%) had meningitis and 11 (38%) had paresthesia.

The mean time for HIV diagnosis was 6.6 ± 7.2 years.

The following were found among the 47 patients with HIV:

• 24 (51%) had a CD4 (T-cell) rate of < 350/mm3
• 16 (34%) were under antiretroviral therapy
• 18 (38.3%) had an undetectable viral load (definition depending on years between 20 and 200cp/ml) at initial diagnosis
• A history of syphilis was more common in patients with HIV than patients without (17% vs 2%, P = .01)
• The T-test in the cerebrospinal fluid (CSF) was significantly more often positive in patients with HIV than patients without (88% vs 76%, P = .04), however no other CSF difference was seen between the 2 groups
• Patients with HIV were more likely to have involvement of both eyes compared with patients without (62% vs 38%, P = .045).
• No difference was seen in the antibiotic management and outcome up to 1 year of follow-up between patients with and without HIV

Additionally, visual acuity consistently improved after antibiotic treatment, but neurologic or ocular impairment was still noted in 54 (34%) of the 96 total patients 6 months after treatment and 40 (18%) patients 12 months after treatment. Nontreponemal serologic reversion was seen in 50 (88%) patients 6 months after treatment.

While the study is limited in that 58% of patients did not follow up at 1 year, the rate is similar in other retrospective studies where it varies from 34% to 64%.

Finally, the authors said early symptomatic NS/OS is increasing, especially OS, and paresthesias and cranial nerve involvement in a patient at risk of syphilis should raise the diagnosis of NS.

“The high rate of sequelae emphasizes the importance of prevention and screening, and calls for the evaluation of an enhanced treatment either by associating corticosteroids or by using higher doses or more prolonged courses of treatment,” the authors concluded.

Reference

Rasoldiera V, Gueudryb J, Chapuzet C, et al. Early symptomatic neurosyphilis and ocular syphilis: A comparative study between HIV-positive and HIV-negative patients. Infectious Diseases Now. Published online October 22, 2021. doi:10.1016/j.medmal.2020.10.016