title: Prognosis of ocular syphilis in patients infected with HIV in the antiretroviral therapy era.
abstract: OBJECTIVE
  To describe the clinical course and prognosis of ocular syphilis in patients infected with HIV-1 in the antiretroviral therapy (ART) era.
  
  
  METHODS
  We conducted a single-centre retrospective chart review of ocular syphilis in patients infected with HIV-1 diagnosed between August 1997 and July 2015. The prognosis of best-corrected visual acuity (BCVA) was analysed.
  
  
  RESULTS
  The study subjects were 30 eyes of 20 men who had sex with men (MSM) (median age, 41). Loss of vision and posterior uveitis were the most common ocular clinical features (43%) and location of inflammation at presentation (50%), respectively. The median baseline BCVA was 0.4 (IQR 0.2-1.2), including three eyes with hand motion. BCVA≤0.4 at diagnosis was significantly associated with posterior uveitis or panuveitis (p=0.044). Seventy-five per cent were treated with intravenous benzylpenicillin and 53% were diagnosed with neurosyphilis. After treatment (median follow-up: 21 months), BCVA improved in 89% of the eyes, including all eyes with hand motion, to a median BCVA of 1.2 (IQR 0.8-1.2). Kaplan-Meier analysis showed that >28 days of ocular symptoms before diagnosis was the only factor associated with poor prognosis of BCVA. Three patients (15%) developed recurrence after treatment.
  
  
  CONCLUSIONS
  The prognosis of BCVA in HIV-infected patients with ocular syphilis in the ART era was favourable after proper treatment. Having >28 days of ocular symptoms before diagnosis was associated with poor prognosis. Changes in visual acuity in HIV-infected MSM should prompt an immediate assessment for ocular syphilis as delays in diagnosis and therapy can lead to irreversible visual loss.
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Tsuboi
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishijima
authors.affiliation: Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Shigeko
authors.initials: S
authors.lastname: Yashiro
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Katsuji
authors.initials: K
authors.lastname: Teruya
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Kikuchi
authors.affiliation: Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Naomichi
authors.initials: N
authors.lastname: Katai
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.|Center for AIDS Research, Kumamoto University, Kumamoto, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Oka
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.|Center for AIDS Research, Kumamoto University, Kumamoto, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Gatanaga
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015818:Eye Infections, Bacterial / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010400:Penicillin G / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D013587:Syphilis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D014792:Visual Acuity
chemical_list: D000900:Anti-Bacterial Agents; D010400:Penicillin G
keywords: ANTIRETROVIRAL THERAPY; HIV; PROGNOSTIC INDICATORS; SYPHILIS