title: Neurosyphilis in HIV-infected patients: clinical manifestations, serum venereal disease research laboratory titers, and associated factors to symptomatic neurosyphilis.
abstract: OBJECTIVE
  To describe clinical and laboratory features of human immunodeficiency infection (HIV)-infected patients with neurosyphilis.
  
  
  METHODS
  Retrospective study of 27 consecutive cases of HIV-infected patients with a positive Venereal Disease Research Laboratory (VDRL) in cerebrospinal fluid (CSF).
  
  
  RESULTS
  Median of age was 36 years and 89% were men. Ten (37%) patients had previous nonneurologic syphilis treatment. At the time of neurosyphilis diagnosis, 10 (37%) patients had early syphilis, and 6 of them were neurologically asymptomatic. Nine (33%) patients had symptomatic neurosyphilis. Twenty-six (96%) patients were classified with early neurosyphilis. The medians of serum VDRL and CD4 T cell counts were 1:128 and 182 cell/muL, respectively. Twenty five (93%) patients presented serum VDRL titers > or =1:16. Five of 6 patients with early syphilis and asymptomatic neurosyphilis, presented serum VDRL > or =1:16. Symptomatic patients showed lower CD4 T cell counts (59 cell/muL vs. 208 cell/muL, P = 0.03) and higher protein concentration on CSF (118 mg/dL vs. 39 mg/dL, P <0.001) than asymptomatic patients.
  
  
  CONCLUSIONS
  Most patients had early and asymptomatic neurosyphilis, and more than one third had early syphilis. Patients with symptomatic neurosyphilis showed lower CD4 T cell counts and higher protein concentration on CSF than those asymptomatic. Most patients had serum VDRL titers > or =1:16, regardless of syphilis stage.
authors.affiliation: Department of Infectious Diseases, Emílio Ribas Institute of Infectious Diseases, Sao Paulo, Brazil.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Poliseli
authors.forename: Jose E
authors.initials: JE
authors.lastname: Vidal
authors.forename: Augusto C
authors.initials: AC
authors.lastname: Penalva De Oliveira
authors.forename: Adrian V
authors.initials: AV
authors.lastname: Hernandez
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D002555:Cerebrospinal Fluid / Q000378:metabolism; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D009494:Neurosyphilis / Q000097:blood / Q000134:cerebrospinal fluid / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D019562:Viral Load