HIV and syphilis: when to perform a lumbar puncture.
OBJECTIVE
The objectives of this study were to determine predictive factors for neurosyphilis in HIV-infected patients with syphilis and optimize the use of lumbar puncture.


METHODS
The authors reviewed 112 cases of HIV-infected patients with syphilis who underwent a lumbar puncture. Diagnosis of neurosyphilis was based on a cerebrospinal fluid white blood cells count > or =20/microL, and/or a reactive cerebrospinal fluid-Venereal Disease Research Laboratory, and/or a positive intrathecal T. pallidum antibody (ITPA) index.


RESULTS
Twenty-six of 112 had neurosyphilis. Neurologic manifestations and serum rapid plasma reagin (RPR) were associated with neurosyphilis (P = 0.036, P = 0.018, respectively). In multivariate analysis, log(2)RPR was still associated with neurosyphilis (P = 0.005). In patients without neurologic manifestations, the risk of neurosyphilis increases gradually with log(2)RPR. A serum RPR of 1/32 seems to be the best cutoff point to decide the performance or not of a lumbar puncture (sensitivity 100%, specificity 40%).


CONCLUSIONS
In HIV-infected patients with syphilis, lumbar puncture could be restricted to those with neurologic manifestations or a serum RPR > or =1/32.
Libois
Agnès
A
Service des maladies infectieuses, CHU Saint-Pierre, 322 rue haute, 1000 Brussels, Belgium. agnes_libois@stpierre-bru.be
De Wit
Stéphane
S
Poll
Bénédicte
B
Garcia
Felipe
F
Florence
Eric
E
Del Rio
Ana
A
Sanchez
Paquita
P
Negredo
Eugenia
E
Vandenbruaene
Marc
M
Gatell
José M
JM
Clumeck
Nathan
N
D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009494:Neurosyphilis / Q000134:cerebrospinal fluid / Q000150:complications* / Q000175:diagnosis* / Q000382:microbiology; D012372:ROC Curve; D011935:Reagins / Q000097:blood*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013129:Spinal Puncture; D013587:Syphilis / Q000134:cerebrospinal fluid / Q000150:complications / Q000382:microbiology; D014210:Treponema pallidum / Q000276:immunology / Q000302:isolation & purification
D011935:Reagins