Normalization of Cerebrospinal Fluid Abnormalities after Neurosyphilis Therapy: Does HIV Status Matter?

Abstract

To identify factors that affect normalization of laboratory measures after treatment for neurosyphilis, 59 subjects with neurosyphilis underwent repeated lumbar punctures and venipunctures after completion of therapy. The median duration of follow-up was 6.9 months. Stepwise Cox regression models were used to determine the influence of clinical and laboratory features on normalization of cerebrospinal fluid (CSF), white blood cells (WBCs), CSF protein concentration, CSF Venereal Disease Research Laboratory (VDRL) reactivity, and serum rapid plasma reagin (RPR) titer. Human immunodeficiency virus (HIV)-infected subjects were 2.5 times less likely to normalize CSF-VDRL reactivity than were HIV-uninfected subjects. HIV-infected subjects with peripheral blood CD4+ T cell counts of < or =200 cells/ mu L were 3.7 times less likely to normalize CSF-VDRL reactivity than were those with CD4+ T cell counts of >200 cells/ mu L. CSF WBC count and serum RPR reactivity were more likely to normalize but CSF-VDRL reactivity was less likely to normalize with higher baseline values. Future studies should address whether more intensive therapy for neurosyphilis is warranted in HIV-infected individuals.

Neurosyphilis and the impact of HIV infection

“…63 In addition, HIV-infected patients with peripheral blood CD4+ T-cells 200 cells uL -1 were 3.3-fold less likely to normalise CSF-VDRL. 63 Thus, HIV-infected patients should undergo regular follow up with repeat CSF testing despite undergoing adequate treatment for neurosyphilis.…”

“…Compared with HIV-uninfected patients, HIV-infected patients with symptomatic neurosyphilis may be more likely to fail neurosyphilis therapy based on clinical and serological criteria, as well as on failure to normalise CSF abnormalities. 32,[59][60][61][62][63][64] In one prospective study, HIV-infected patients were 2.5-fold less likely to normalise CSF-VDRL after appropriate therapy compared with HIV-uninfected patients. 63 In addition, HIV-infected patients with peripheral blood CD4+ T-cells 200 cells uL -1 were 3.3-fold less likely to normalise CSF-VDRL.…”

“…32,[59][60][61][62][63][64] In one prospective study, HIV-infected patients were 2.5-fold less likely to normalise CSF-VDRL after appropriate therapy compared with HIV-uninfected patients. 63 In addition, HIV-infected patients with peripheral blood CD4+ T-cells 200 cells uL -1 were 3.3-fold less likely to normalise CSF-VDRL. 63 Thus, HIV-infected patients should undergo regular follow up with repeat CSF testing despite undergoing adequate treatment for neurosyphilis.…”

Serologic Response to Treatment in Syphilis

“…After therapy, the changes in CSF VDRL or CSF protein occur more slowly than cell counts, and persistent abnormalities might be less important. The leukocyte count is a sensitive measure of the effectiveness of therapy (Marra et al, 2000;Marra et al, 2004b). Resolution of all serum and CSF abnormalities were resolved by 30 weeks in most patients not infected with HIV (Marra et al, 1996).…”

Indicações da punção liquórica nos portadores de sífilis

“…E, quando as contagens séricas dos linfócitos T CD4+ forem inferiores a 200 céls/mm 3 , esse teste regulariza menos 3,7 vezes que naqueles que têm mais que 200 dessas células/mm 3 . 26 Doentes soropositivos para o HIV têm maior chance de desenvolver neurolues, 3,27 sendo importante afastar o diagnóstico em todos esses casos. 10 Entretanto, punção liquórica em todos os coinfectados HIV/sífilis é controversa.…”