Section of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung City, Taiwan.
J Microbiol Immunol Infect. 2012 Oct;45(5):337-42. doi: 10.1016/j.jmii.2011.12.011. Epub 2012 Jun 13.
Some studies have reported that the risk factors for neurosyphilis in patients with human immunodeficiency virus (HIV) and syphilis co-infection, include CD4 cell counts ≤350cells/μL and rapid plasma reagin (RPR) titer ≥1:32. However, neurosyphils can develop even in patients with CD4 cell counts >350cells/μL or RPR titer <1:32. In this study, we evaluated the outcome of syphilis to treatment in HIV-infected patients, and analysed the predictors of neurosyphilis in this population.
We retrospectively reviewed medical records of HIV-infected patients with syphilis who visited the China Medical University Hospital between January 2000 and December 2009. Neurosyphilis was defined by white blood cell (WBC) counts >20cells/μL in the cerebrospinal fluid (CSF) sample or elevated Venereal Disease Research Laboratory (VDRL) titers of the CSF samples. Treatment failure was defined as less than 4-fold decrease in the serum RPR titer at or beyond 12 months post-treatment in case of early syphilis, and, at or beyond 24 months in case of late syphilis.
One hundred and twenty-one HIV-infected patients (average age, 32 years) with syphilis were included in this study. Of 63 patients who had follow-up of serologic responses, 30 (47.6%) failed to respond to treatment. CD4 cell counts ≤200cells/μL was the indicator for treatment failure (P=.029). Lumbar puncture was performed in 65 patients, and 14 patients were diagnosed with neurosyphilis. At the time of lumbar puncture, 31 and 19 of the 65 patients showed CD4 cell counts of >350cells/μL and RPR of <1:32, respectively. An HIV viral load (VL) ≥10000copies/mL was found to be associated with the development of neurosyphilis (P=.016).
In HIV-infected patients with syphilis, RPR titer should be evaluated more frequently when CD4 count ≤200cell/μL is associated with treatment failure. Lumbar puncture for the diagnosis of neurosyphilis should be considered in patients with HIV and syphilis co-infection, even in patients with CD4 cell counts >350cells/μL, and particularly when the HIV VL ≥10000copies/mL.
一些研究报告称，人类免疫缺陷病毒（HIV）和梅毒合并感染患者发生神经梅毒的危险因素包括 CD4 细胞计数≤350 个/μL 和快速血浆反应素（RPR）滴度≥1:32。然而，即使在 CD4 细胞计数>350 个/μL 或 RPR 滴度<1:32 的患者中，也可能发生神经梅毒。在这项研究中，我们评估了 HIV 感染患者梅毒治疗的结果，并分析了该人群中发生神经梅毒的预测因素。
我们回顾性分析了 2000 年 1 月至 2009 年 12 月期间在中国医科大学医院就诊的 HIV 感染合并梅毒患者的病历。通过脑脊液（CSF）样本中白细胞（WBC）计数>20 个/μL 或 CSF 样本中性病研究实验室（VDRL）滴度升高来定义神经梅毒。早期梅毒治疗后 12 个月或更久时血清 RPR 滴度未下降 4 倍以上，晚期梅毒治疗后 24 个月或更久时血清 RPR 滴度未下降 4 倍以上定义为治疗失败。
本研究共纳入 121 例 HIV 感染合并梅毒患者（平均年龄 32 岁）。在 63 例有血清学反应随访的患者中，有 30 例（47.6%）治疗失败。CD4 细胞计数≤200 个/μL 是治疗失败的指标（P=.029）。对 65 例患者进行了腰椎穿刺，其中 14 例被诊断为神经梅毒。腰椎穿刺时，65 例患者中有 31 例和 19 例 CD4 细胞计数>350 个/μL 和 RPR<1:32。发现 HIV 病毒载量（VL）≥10000 拷贝/mL 与神经梅毒的发生有关（P=.016）。
在 HIV 感染合并梅毒的患者中，当 CD4 计数≤200 个/μL 与治疗失败相关时，应更频繁地评估 RPR 滴度。对于 HIV 和梅毒合并感染的患者，即使 CD4 细胞计数>350 个/μL，特别是当 HIV VL≥10000 拷贝/mL 时，应考虑腰椎穿刺以诊断神经梅毒。
