Haule Adeodatus, Msemwa Betrand, Mgaya Evarista, Masikini Peter, Kalluvya Samuel
Department of Medicine, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania.
Laboratory, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania.
BMC Public Health. 2020 Dec 4;20(1):1862. doi: 10.1186/s12889-020-09984-9.
HIV-syphilis co-infection can enhance the rapid progression of early or late latent syphilis to neurosyphilis and can cause catastrophic neurological complications. In studies in Mwanza, syphilis affects ~ 8% of healthy outpatients and studies done in the 1990s have suggested that up to 23.5% of HIV-syphilis co-infected patients also have neurosyphilis.
This was a cross sectional study in which adult HIV infected patients who were hospitalized or attending the outpatient Care and Treatment Clinic (CTC) were interviewed using a structured questionnaire and screened for syphilis using serum Treponema Pallidum Hemagglutination Assay (TPHA). Blood was also taken for CD4+ T cells and viral load. Those who were found to have syphilis underwent neurological examination for any neurologic deficit and were offered a lumbar puncture.
The prevalence of syphilis in HIV infected patients was found to be 9.6%. The majority of patients were female (72.5%) and median age was 42 years [interquartile range, 32-50]. Most patients were on ART (99.4%). In the study population of 1748 participants, 9.6% were TPHA positive; the majority (89.2%) reported not knowing their syphilis status and not previously been treated. One hundred and forty-one participants with syphilis had neurological examinations performed. Four of these had abnormal findings that necessitated a lumbar puncture. Neurosyphilis was confirmed in one patient (0.7%).
The high prevalence of syphilis in HIV infected patients indicates that there is a need to increase efforts in targeting this population to reduce sexually transmitted infections. Screening for syphilis should be done for all HIV patients given the high prevalence of the infection and the risk that aggressive forms of neurosyphilis can occur despite recovery of CD4+ T cell counts in untreated syphilis.
HIV与梅毒合并感染可加速早期或晚期潜伏梅毒向神经梅毒的快速进展，并可导致灾难性的神经并发症。在姆万扎的研究中，梅毒影响约8%的健康门诊患者，20世纪90年代进行的研究表明，高达23.5%的HIV与梅毒合并感染患者也患有神经梅毒。
这是一项横断面研究，对住院或在门诊护理与治疗诊所（CTC）就诊的成年HIV感染患者使用结构化问卷进行访谈，并采用血清梅毒螺旋体血凝试验（TPHA）筛查梅毒。同时采集血液检测CD4+T细胞和病毒载量。那些被发现患有梅毒的患者接受神经功能缺损的神经系统检查，并接受腰椎穿刺检查。
HIV感染患者中梅毒的患病率为9.6%。大多数患者为女性（72.5%），中位年龄为42岁[四分位间距，32 - 50岁]。大多数患者正在接受抗逆转录病毒治疗（ART，99.4%）。在1748名参与者的研究人群中，9.6%的人TPHA呈阳性；大多数人（89.2%）表示不知道自己的梅毒状态且之前未接受过治疗。141名患有梅毒的参与者接受了神经系统检查。其中4人有异常发现，需要进行腰椎穿刺。确诊1例神经梅毒患者（0.7%）。
HIV感染患者中梅毒的高患病率表明，需要加大针对该人群的工作力度，以减少性传播感染。鉴于感染的高患病率以及未经治疗的梅毒患者即使CD4+T细胞计数恢复仍可能发生侵袭性神经梅毒的风险，应对所有HIV患者进行梅毒筛查。
