Marra C M, Deutsch R, Collier A C, Morgello S, Letendre S, Clifford D, Gelman B, McArthur J, McCutchan J A, Simpson D M, Duarte N A, Heaton R K, Grant I
Department of Neurology, University of Washington, Seattle, WA, USA.
Int J STD AIDS. 2013 May;24(5):351-5. doi: 10.1177/0956462412472827. Epub 2013 Jun 14.
Cognitive impairment is common in HIV-infected individuals, as is syphilis. Treponema pallidum, the bacterium that causes syphilis, invades the central nervous system early in disease. We hypothesized that HIV-infected patients with a history of syphilis or neurosyphilis would have more cognitive impairment than HIV-infected individuals without these infections. Eighty-two of 1574 enrollees in CHARTER, a prospective, observational study, had reactive serum rapid plasma reagin (RPR) tests. They were matched to 84 controls with non-reactive RPR by age, gender, ethnicity and HIV risk factor. Participants underwent comprehensive neuropsychological (NP) evaluations. RPR results were confirmed and serum fluorescent treponemal antibody absorption (FTA-ABS) test reactivity determined at a central laboratory. Sera from 101 of 166 participants were FTA-ABS reactive, indicating past or current syphilis. Among the 136 individuals without confounding conditions, compared with patients who had never had syphilis, those with prior syphilis had a greater number of impaired NP test domains (1.90 SD [1.77] versus 1.25 [1.52], P = 0.03), a higher global deficit score (0.47 [0.46] versus 0.31 [0.33], P = 0.03), and more were impaired in the NP learning domain (36 [42.9%] of 84 versus 13 [25.0%] of 52, P = 0.04). These effects of prior syphilis remained after controlling for education and premorbid intelligence.
认知障碍在感染HIV的个体中很常见，梅毒感染个体中也是如此。引起梅毒的苍白密螺旋体在疾病早期就会侵入中枢神经系统。我们假设，有梅毒或神经梅毒病史的HIV感染患者比没有这些感染的HIV感染个体有更多的认知障碍。在一项前瞻性观察研究CHARTER的1574名登记者中，有82人血清快速血浆反应素环状卡片试验（RPR）呈阳性。根据年龄、性别、种族和HIV风险因素，将他们与84名RPR阴性的对照者进行匹配。参与者接受了全面的神经心理学（NP）评估。RPR结果在中心实验室得到确认，并测定了血清荧光密螺旋体抗体吸收试验（FTA-ABS）的反应性。166名参与者中有101人的血清FTA-ABS呈反应性，表明过去或现在感染过梅毒。在136名没有混杂因素的个体中，与从未感染过梅毒的患者相比，既往感染过梅毒的患者NP测试受损领域更多（1.90标准差[1.77]对1.25[1.52]，P = 0.03），整体缺陷评分更高（0.47[0.46]对0.31[0.33]，P = 0.03），并且在NP学习领域受损的人数更多（84人中36人[42.9%]对52人中13人[25.0%]，P = 0.04）。在控制了教育程度和病前智力因素后，既往梅毒感染的这些影响依然存在。
