title: Neurocognitive impairment in HIV-infected individuals with previous syphilis.
abstract: Cognitive impairment is common in HIV-infected individuals, as is syphilis. Treponema pallidum, the bacterium that causes syphilis, invades the central nervous system early in disease. We hypothesized that HIV-infected patients with a history of syphilis or neurosyphilis would have more cognitive impairment than HIV-infected individuals without these infections. Eighty-two of 1574 enrollees in CHARTER, a prospective, observational study, had reactive serum rapid plasma reagin (RPR) tests. They were matched to 84 controls with non-reactive RPR by age, gender, ethnicity and HIV risk factor. Participants underwent comprehensive neuropsychological (NP) evaluations. RPR results were confirmed and serum fluorescent treponemal antibody absorption (FTA-ABS) test reactivity determined at a central laboratory. Sera from 101 of 166 participants were FTA-ABS reactive, indicating past or current syphilis. Among the 136 individuals without confounding conditions, compared with patients who had never had syphilis, those with prior syphilis had a greater number of impaired NP test domains (1.90 SD [1.77] versus 1.25 [1.52], P = 0.03), a higher global deficit score (0.47 [0.46] versus 0.31 [0.33], P = 0.03), and more were impaired in the NP learning domain (36 [42.9%] of 84 versus 13 [25.0%] of 52, P = 0.04). These effects of prior syphilis remained after controlling for education and premorbid intelligence.
authors: Department of Neurology, University of Washington, Seattle, WA, USA. cmarra@u.washington.edu
authors: C M
authors: CM
authors: Marra
authors: R
authors: R
authors: Deutsch
authors: A C
authors: AC
authors: Collier
authors: S
authors: S
authors: Morgello
authors: S
authors: S
authors: Letendre
authors: D
authors: D
authors: Clifford
authors: B
authors: B
authors: Gelman
authors: J
authors: J
authors: McArthur
authors: J A
authors: JA
authors: McCutchan
authors: D M
authors: DM
authors: Simpson
authors: N A
authors: NA
authors: Duarte
authors: R K
authors: RK
authors: Heaton
authors: I
authors: I
authors: Grant
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology*; D005260:Female; D016508:Fluorescent Treponemal Antibody-Absorption Test; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009494:Neurosyphilis / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D011446:Prospective Studies; D013587:Syphilis / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D013588:Syphilis Serodiagnosis; D014210:Treponema pallidum / Q000276:immunology* / Q000302:isolation & purification
keywords: AIDS; HIV; Treponema pallidum; central nervous system; neurocognitive impairment; neurosyphilis; sexually transmitted infection; syphilis
references: Neurology. 2007 Oct 30;69(18):1789-99
references: 17914061
references: J Infect Dis. 2004 Feb 1;189(3):369-76
references: 14745693
references: Clin Infect Dis. 2006 Sep 15;43(6):787-90
references: 16912958
references: AIDS. 2004 Oct 21;18(15):2075-9
references: 15577629
references: Sex Transm Dis. 2005 May;32(5):265-9
references: 15849526
references: J Acquir Immune Defic Syndr. 2007 Mar 1;44(3):356-9
references: 17159654
references: J Acquir Immune Defic Syndr. 2008 Feb 1;47(2):234-40
references: 18340654
references: Neurology. 2009 Sep 8;73(10):768-74
references: 19738171
references: J Leukoc Biol. 2008 Oct;84(4):932-9
references: 18495785
references: Arch Intern Med. 2012 Sep 10;172(16):1237-43
references: 22826097
references: J Clin Exp Neuropsychol. 2008 Oct;30(7):836-43
references: 18608693
references: Acta Neurol Scand. 1999 Sep;100(3):178-84
references: 10478582
references: Sex Transm Dis. 1997 Aug;24(7):398-401
references: 9263360
references: J Clin Exp Neuropsychol. 2004 Sep;26(6):759-78
references: 15370374
references: Sex Transm Dis. 2009 May;36(5):300-4
references: 19265730
references: J Acquir Immune Defic Syndr. 2011 Dec 1;58(4):408-16
references: 21857351
references: N Engl J Med. 1997 Jul 31;337(5):307-14
references: 9235493
references: J Neurovirol. 2010 Feb;16(1):6-12
references: 20132081
references: Sex Transm Dis. 2006 Mar;33(3):143-8
references: 16505739
references: Neurology. 2010 Dec 7;75(23):2087-96
references: 21135382
references: Sex Transm Dis. 2005 Jul;32(7):458-63
references: 15976605
references: Sex Transm Dis. 2008 May;35(5):430-4
references: 18446083
references: Clin Microbiol Rev. 1995 Jan;8(1):1-21
references: 7704889
references: Neurology. 1998 Oct;51(4):957-61
references: 9781512