title: Ocular syphilis among HIV-infected patients: a systematic analysis of the literature.
abstract: BACKGROUND
  Ocular syphilis among HIV-infected patients continues to be a problem in the highly active antiretroviral therapy (HAART) era. However, outside of case reports or small case series, little is known about the clinical, laboratory, and treatment outcomes of these patients. Objective To examine the literature on HIV-infected patients and determine the results of treatment.
  
  
  METHODS
  Systematic review of cases series and case reports among HIV-infected individuals with ocular syphilis. Reviews, languages other than English and pre-1980 reports were excluded. The effect of CD4 count and virological suppression on clinical manifestations and diagnostic laboratory values was evaluated.
  
  
  RESULTS
  A total of 101 HIV-infected individuals in case series and case reports were identified. Ocular syphilis led to the HIV diagnosis in 52% of cases, including patients with CD4 count >200 cells/mm(3). Posterior uveitis was significantly more common in individuals with CD4 count <200 cells/mm(3) (p = 0.002). Three patients with confirmed ocular syphilis had negative non-treponemal tests. Ninety-seven per cent of patients with visual impairment improved following intravenous penicillin or ceftriaxone.
  
  
  CONCLUSIONS
  Non-treponemal tests may be negative in HIV-infected patients with ocular syphilis. Ocular syphilis remains an important clinical manifestation that can lead to initial HIV diagnosis.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRJ-504, Boston 02114, USA. jtucker4@partners.org
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tucker
authors.forename: Jonathan Z
authors.initials: JZ
authors.lastname: Li
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Robbins
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Davis
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Lobo
authors.forename: Jan
authors.initials: J
authors.lastname: Kunkel
authors.forename: George N
authors.initials: GN
authors.lastname: Papaliodis
authors.forename: Marlene L
authors.initials: ML
authors.lastname: Durand
authors.forename: Donna
authors.initials: D
authors.lastname: Felsenstein
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015818:Eye Infections, Bacterial / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D013587:Syphilis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D055815:Young Adult
chemical_list: D012367:RNA, Viral
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