Does HIV Status Affect Neurosyphilis or Ocular Syphilis Outcomes?

Patients with HIV infection who also have early symptomatic neurosyphilis or ocular syphilis are more likely to be younger, be men who have sex with men, and have a history of syphilis compared with patients without HIV infection who also have neurosyphilis or ocular syphilis, according to study results published in Infectious Diseases Now. Results also suggested that positive HIV infection does not affect the outcomes of neurosyphilis or ocular syphilis.

To better understand the relationship between syphilis and HIV, a team of investigators in France conducted a study that compared the outcomes and clinical characteristics of early symptomatic neurosyphilis and ocular syphilis among patients with or without HIV infection.

A total of 96 patients (93% men; 49% HIV positive) were included in the study; 67 had ocular syphilis, 15 had neurosyphilis, and 14 had both.

Among patients with HIV infection, the mean time to HIV diagnosis was 6.6 ± 7.2 years. A history of syphilis was more common among patients with HIV infection compared with those without HIV infection (17% vs 2%, respectively; P =.01). In addition, patients with HIV infection were more likely to be men who have sex with men (P =.00048). Patients with HIV infection also were more likely to have involvement of both eyes compared with those without HIV infection (62% vs 38%, respectively; P =.045).

Neurologic symptoms were noted in 29 patients; 21 had cranial nerve involvement, 7 had severe meningitis, and 11 had paresthesia. The main cranial nerves involved included VIII (76%), V (19%), III (5%), and VII (5%). Positive cerebrospinal fluid treponemal tests were more common in patients with HIV infection compared with those without HIV (88% vs 76%; P =.04).

Although visual acuity consistently improved after treatment with antibiotics, neurologic or ocular impairment was noted in 34% of patients (n=54) 6 months after treatment and in 18% of patients (n=40) 12 months after treatment. Nontreponemal serologic reversion was noted in 88% of patients (n=50) 6 months after treatment.

“The high rate of sequelae emphasizes the importance of prevention and screening, and calls for the evaluation of an enhanced treatment either by associating corticosteroids or by using higher doses or more prolonged courses of treatment,” the investigators concluded.

Reference

Rasoldier V, Gueudry J, Chapuzet C, et al Early symptomatic neurosyphilis and ocular syphilis: a comparative study between HIV-positive and HIV-negative patients. Infect Dis Now. 2021;51(4):351-356. doi:10.1016/j.medmal.2020.10.016