Evaluation of Cerebrospinal Fluid (CSF) in Patients with HIV/Syphilis Co-Infection Followed at Institute of Infectology Emilio Ribas, Brazil

Background:

Sexually transmitted diseases (STDs) among HIV-infected patients are a huge public health challenge in the world. Co-infection HIV/syphilis may be responsible for an acellerated and fulminant course of syphilis, including neurosyphilis. The aim fo this research was to assess the prevalence of neurosyphilis in co-infected patients and analyse their clinical situation.

Methods:

From January 2007 to December 2007, a total of 861 examination of cerebrospinal fluid (CSF) was performed at Clinical Laboratory from Institute of Infectology Emílio Ribas, São Paulo city. Of these 861 patients, 21 were reactive for neuroshyphilis and for HIV. Retrospective analysis of clinical records and laboratory findings of these co-infected patients were carried out. Syphilis serology was performed on both CSF and serum (VDRL and TPHA assays). Neurosyphilis was defined by positive TPHA test in CSF.

Results:

Overall prevalence of neurosyphilis was 2.34%. Clinical data of 21 co-infected patients were analyzed. 15 males (71.42%) and 6 females (28,57%). Median age was 42 years. Mean CD4 cout was 324 cells/µL (range: 34-940). 11 (52.38%) patients were using HAART and 1 patient had stopped ARV therapy. Eight (38%) patients showed clinical manifestations of secondary syphilis. Neurological symptoms were observed in 7 (33.3%) patients. Mean CSF VDRL was 1:4 (range: negative-1:8); mean CSF TPHA was 1:117 (range: 1:40-1:640); mean CSF cell count was 49 (range: 1-400); mean CSF protein concentration was 87 (range: 31-439); mean CSF glucose concentration was 52 (range: 17-61). In all patients, positive VDRL in serum was detected in routine screening test and confirmed by haemagglutination assay.

Conclusion:

Many countries are observing re-emergence of STDs, including Brazil. In our hospital neurosyphilis is more common in male patients with HIV infection. A significative number of patients had dermatological symptoms. During the course of HIV infection the natural course of syphilis can be modified - syphilis could contribute to brain barrier injury. Improved information and targeted education programs mut be improvement, to avoid delayed syphilis recognition.

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