NATAP/CROI: HAART Cuts Neurosyphilis Risk

[Guest guest]

Subject: NATAP/CROI: HAART Cuts Neurosyphilis Risk

Antiretrovirals May Cut

Neurosyphilis Risk and Improve Response to Neurosyphilis Therapy

19th Conference on

Retroviruses and Opportunistic Infections, March 5-8, 2012, Seattle

Mark Mascolini

HIV-positive people not taking antiretroviral therapy (ART) had a twice higher

risk of neurosyphilis than those on ART, according to results of a 519-person

study [1]. And antiretroviral-treated people responded to neurosyphilis therapy

faster than those not taking antiretrovirals. Antiretroviral central nervous

system (CNS) penetration did not influence either finding.

In the United States and Europe syphilis rates rose dramatically in

HIV-positive people--usually men who have sex with men (MSM)--with the advent

of triple antiretroviral therapy in the late 1990s. Several studies found that

neurosyphilis is more common in HIV-positive people with a serum rapid plasma

reagin (RPR) titer at or above 1:32 and a CD4 count at or below 350 [2-4]. And

some work suggests that neurosyphilis is more common in people not on ART [5],

the hypothesis explored in this study of HIV-positive people with syphilis in

Seattle, Washington [1].

Marra and University of Washington colleagues reported that these 519

people with syphilis all had a neurologic exam and underwent lumbar puncture

and venipuncture. The group included 133 people (26%) treated for neurosyphilis

who had follow-up 3, 6, and 12 months after neurosyphilis therapy.

Median age was similar in the overall group and the neurosyphilis group (39 and

38), and 97% in both groups were MSM. Prevalence of early versus late-stage

syphilis was 76% in the overall group and 74% in the neurosyphilis group.

Respective serum RPR titers were 1:64 and 1:128. Median CD4 count and viral load

were 424 and 401 and 3.24 and 4.29 log10 copies/mL in the overall group and the

neurosyphilis group. While 53% in the overall group were on ART, only 32% in

the neurosyphilis group were taking antiretrovirals.

Multivariate analysis considering ART status, RPR titer, syphilis stage, and

year of syphilis diagnosis determined that not

taking ART and three other factors independently raised the risk of symptomatic

neurosyphilis or

neurosyphilis defined as a reactive cerebrospinal fluid (CSF) VDRL test, at the following odds ratios (OR) (and 95% confidence

intervals):

Off ART:

Symptomatic neurosyphilis: OR

2.4 (1.4 to 4.2), P < 0.01

Reactive CSF-VDRL: OR 2.1 (1.2 to 3.7), P

< 0.01)

RPR titer at or above 1:32:

Symptomatic neurosyphilis: OR

3.3 (1.5 to 7.2), P < 0.01

Reactive CSF-VDRL: OR 10.1 (3.7 to 27.1), P

< 0.001

Late-stage syphilis:

Reactive CSF-VDRL: OR 3.0 (1.6 to 5.6), P

< 0.001

Syphilis diagnosed before 2006:

Reactive CSF-VDRL: OR 1.7 (1.0 to 3.1), P

= 0.05

Among people on ART, antiretroviral CNS penetration score did not affect risk

of neurosyphilis.

Among people with a reactive CSF-VDRL, the white blood cell count in CSF normalized significantly more quickly with

neurosyphilis therapy in those taking ART than in those off ART (P = 0.001). Antiretroviral CNS

penetration score did not affect this result.

Marra and colleagues believe their findings "suggest that host immune status is an important determinant of

the course of syphilis and neurosyphilis in HIV-infected patients."

References

1.

Marra C, Ho E, Tantalo L, Sahi S, Dunaway S, T, Lukehart S. ARV

use decreases neurosyphilis risk and improves response to neurosyphilis therapy.

19th

Conference on Retroviruses and Opportunistic Infections. March 5-8, 2012.

Seattle. Abstract 486. http://www.retroconference.org/2012b/PDFs/486.pdf.

2. Marra CM, Maxwell CL, SL, et al. Cerebrospinal fluid abnormalities in

patients with syphilis: association with clinical and laboratory features. J

Infect Dis. 2004;189:369-376. http://jid.oxfordjournals.org/content/189/3/369.long.

3. Libois A, De Wit S, Poll B, et al. HIV and syphilis: when to perform a

lumbar puncture. Sex Transm Dis. 2007;34:141-144.

4. Ghanem KG, RD, Rompalo AM, et al. Lumbar puncture in HIV-infected

patients with syphilis and no neurologic symptoms. Clin Infect Dis.

2009;48:816-821. Erratum in Clin Infect Dis. 2009;48:1491. http://cid.oxfordjournals.org/content/48/6/816.long.

5. Ghanem KG, RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA. Neurosyphilis

in a clinical cohort of HIV-1-infected patients. AIDS. 200;22:1145-1151. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2553365/?tool=pubmed.