Neurosyphilis in Human Immunodeficiency Virus Type 1-Seropositive Individuals: A Prospective Study

doi:10.1001/archneur.1991.00530190046014

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Vol. 48 No. 7, July 1991

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Neurosyphilis in Human Immunodeficiency Virus Type 1-Seropositive Individuals

A Prospective Study

Joseph R. Berger, MD

Arch Neurol. 1991;48(7):700-702.

Abstract

• The prevalence of neurosyphilis in human immunodeficiencyvirus type 1 (HIV-1)-seropositive (HIV+) persons was assessedduring the course of a study of the neurological complicationsof HIV-1 infection. One hundred sixty-six asymptomatic HIV+subjects, 63 neurologically symptomatic HIV + subjects, andsix at-risk HIV-1—seronegative (HIV-) control subjectsunderwent cerebrospinal fluid (CSF) analysis on entry into thislongitudinal study. Three (1.8%) of the asymptomatic HIV+ subjectshad both a reactive CSF VDRL test and a reactive CSF fluorescenttreponemal antibody-absorption (FTA-ABS) test. Two of thesethree subjects had a history of appropriately treated earlysyphilis, and all had a reactive serum rapid plasma reagin test.Of the 63 neurologically symptomatic HIV+ subjects, one patientwith dementia had both a reactive CSF VDRL test and a fluorescenttreponemal antibody-absorption test. Subjective improvementin cognitive skills followed high-dose, intravenous penicillintherapy. Another subject had a penicillin-responsive myelopathyaccompanied by a reactive CSF fluorescent treponemal antibody-absorptiontest result, but a nonreactive CSF VDRL. Unsuspected neurosyphilisis relatively common in our population of asymptomatic HIV+subjects and may be responsible for neurological disease ina significant minority of neurologically symptomatic HIV+ persons.Cerebrospinal fluid examination should be performed in all HIV+persons with a history of syphilis or serological evidence ofsyphilis, regardless of prior treatment. Additionally, neurosyphilisshould be considered in the differential diagnosis of neurologicaldisease in any HIV+ person.

Author Affiliations

From the Departments of Neurology and Internal Medicine and the Comprehensive AIDS Center of the University of Miami School of Medicine, Miami, Fla.

Footnotes

Accepted for publication January 16, 1991.

Reprint requests to Department of Neurology, University of MiamiSchool of Medicine, 1501 NW 9th Ave, Miami, FL 33136 (Dr Berger).

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