Risk factors for neurosyphilis in HIV patients: A retrospective cohort study
Introduction: Syphilis is a highly prevalent sexually transmitted infection worldwide. Patients living with Human Immunodeficiency Virus (HIV) have a higher risk of developing neurosyphilis. Actual guidelines advise to proceed with lumbar puncture only if neurologic symptoms are present. However, as...
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Elsevier
2025-05-01
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| Series: | Brazilian Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1413867025000224 |
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| author | Beatriz Arns Tarsila Vieceli Eduardo Gomes Mariana Horn Scherer Luisa Nakashima Maria Luisa Santos Ronara Blos Hepp Fernanda Greinert Maria Helena Rigatto |
| author_facet | Beatriz Arns Tarsila Vieceli Eduardo Gomes Mariana Horn Scherer Luisa Nakashima Maria Luisa Santos Ronara Blos Hepp Fernanda Greinert Maria Helena Rigatto |
| author_sort | Beatriz Arns |
| collection | DOAJ |
| description | Introduction: Syphilis is a highly prevalent sexually transmitted infection worldwide. Patients living with Human Immunodeficiency Virus (HIV) have a higher risk of developing neurosyphilis. Actual guidelines advise to proceed with lumbar puncture only if neurologic symptoms are present. However, asymptomatic neurosyphilis patients are not rare in the HIV population and other risk factors should be defined to guide screening. Methods: We performed a retrospective cohort to evaluate risk factors related to neurosyphilis in HIV patients. Adults with HIV infection and laboratory confirmed syphilis between 2011 and 2021 were included. Patients with no record of syphilis treatment, VDRL titers ≤ 1:4, other neurologic diseases or non-HIV related immunological impairment were excluded. The patients were followed for 2-years after syphilis diagnosis. Results: One-hundred and forty patients (190 syphilis episodes) were included, with mean age of 45.0 ± 9.2-years-old, 111 (79.3 %) were male, 48 (25.8 %) had CD4 count ≤ 350 cells/mm3 at syphilis diagnosis (median: 522.5 cells/mm3; IQR: 315.5‒703.5), 127 (66.8 %) of 172 had a HIV viral load ≤ 400 copies/mm3 and median serum VDRL titer was 1:64 (IQR: 1:16‒1:128). In multivariate analysis, serum VDRL titers ≥ 1:32 and the presence of neurologic symptoms were associated with neurosyphilis, while HIV viral load ≤ 400 copies/mm3 was a protective factor. Discussion: In addition to the presence of neurological symptoms, HIV viral load > 400 copies/mm3 and VDRL titers ≥ 1:32 were shown to be risk factors for neurosyphilis in this study and diagnostic lumbar puncture should be considered in these cases. |
| format | Article |
| id | doaj-art-b8cda1bd83f84549b6cd4c19d41f7318 |
| institution | OA Journals |
| issn | 1413-8670 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Infectious Diseases |
| spelling | doaj-art-b8cda1bd83f84549b6cd4c19d41f73182025-08-20T01:51:50ZengElsevierBrazilian Journal of Infectious Diseases1413-86702025-05-0129310451910.1016/j.bjid.2025.104519Risk factors for neurosyphilis in HIV patients: A retrospective cohort studyBeatriz Arns0Tarsila Vieceli1Eduardo Gomes2Mariana Horn Scherer3Luisa Nakashima4Maria Luisa Santos5Ronara Blos Hepp6Fernanda Greinert7Maria Helena Rigatto8Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, BrazilHospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, BrazilUniversidade Federal do Rio Grande do Sul, Porto Alegre, RS, BrazilPontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, BrazilPontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, BrazilPontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, BrazilPontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, BrazilPontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, BrazilHospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Departamento de Medicina Interna, Porto Alegre, RS, Brazil; Corresponding author. Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St, Porto Alegre, 90.035-903, Brazil.Introduction: Syphilis is a highly prevalent sexually transmitted infection worldwide. Patients living with Human Immunodeficiency Virus (HIV) have a higher risk of developing neurosyphilis. Actual guidelines advise to proceed with lumbar puncture only if neurologic symptoms are present. However, asymptomatic neurosyphilis patients are not rare in the HIV population and other risk factors should be defined to guide screening. Methods: We performed a retrospective cohort to evaluate risk factors related to neurosyphilis in HIV patients. Adults with HIV infection and laboratory confirmed syphilis between 2011 and 2021 were included. Patients with no record of syphilis treatment, VDRL titers ≤ 1:4, other neurologic diseases or non-HIV related immunological impairment were excluded. The patients were followed for 2-years after syphilis diagnosis. Results: One-hundred and forty patients (190 syphilis episodes) were included, with mean age of 45.0 ± 9.2-years-old, 111 (79.3 %) were male, 48 (25.8 %) had CD4 count ≤ 350 cells/mm3 at syphilis diagnosis (median: 522.5 cells/mm3; IQR: 315.5‒703.5), 127 (66.8 %) of 172 had a HIV viral load ≤ 400 copies/mm3 and median serum VDRL titer was 1:64 (IQR: 1:16‒1:128). In multivariate analysis, serum VDRL titers ≥ 1:32 and the presence of neurologic symptoms were associated with neurosyphilis, while HIV viral load ≤ 400 copies/mm3 was a protective factor. Discussion: In addition to the presence of neurological symptoms, HIV viral load > 400 copies/mm3 and VDRL titers ≥ 1:32 were shown to be risk factors for neurosyphilis in this study and diagnostic lumbar puncture should be considered in these cases.http://www.sciencedirect.com/science/article/pii/S1413867025000224HIVSyphilisNeurosyphilisLumbar punctureRisk factors |
| spellingShingle | Beatriz Arns Tarsila Vieceli Eduardo Gomes Mariana Horn Scherer Luisa Nakashima Maria Luisa Santos Ronara Blos Hepp Fernanda Greinert Maria Helena Rigatto Risk factors for neurosyphilis in HIV patients: A retrospective cohort study Brazilian Journal of Infectious Diseases HIV Syphilis Neurosyphilis Lumbar puncture Risk factors |
| title | Risk factors for neurosyphilis in HIV patients: A retrospective cohort study |
| title_full | Risk factors for neurosyphilis in HIV patients: A retrospective cohort study |
| title_fullStr | Risk factors for neurosyphilis in HIV patients: A retrospective cohort study |
| title_full_unstemmed | Risk factors for neurosyphilis in HIV patients: A retrospective cohort study |
| title_short | Risk factors for neurosyphilis in HIV patients: A retrospective cohort study |
| title_sort | risk factors for neurosyphilis in hiv patients a retrospective cohort study |
| topic | HIV Syphilis Neurosyphilis Lumbar puncture Risk factors |
| url | http://www.sciencedirect.com/science/article/pii/S1413867025000224 |
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