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Response to treatment of neurosyphilis in HIV-infected patients.
Civen RH; Wong J; O'Brien WA; George WL; Haake DA; West Los Angeles V.A.
December 30, 1995
Natl Conf Hum Retroviruses Relat Infect (1st). 1993 Dec 12-16;:141.

There is a lack of data on the response to treatment of syphilis in HIV-infected individuals. We retrospectively reviewed all medical records of HIV-infected patients evaluated for neurosyphilis from August 1987 to October 1992 at the West Los Angeles VAMC. Twelve cases of neurosyphilis (four symptomatic and eight asymptomatic) and seventeen cases of late syphilis were found. Seven patients had a positive CSF VDRL and five had presumed neurosyphilis based upon CSF pleocytosis and elevated protein concentrations. Patients with symptomatic neurosyphilis had higher peripheral RPR titers, lower CD4 cell counts, greater CSF pleocytosis and protein concentrations than asymptomatic patients. Patients with neurosyphilis had higher peripheral RPR titers and lower CD4 cell counts than patients with late latent syphilis. All patients with neurosyphilis had treatment with high-dose IV penicillin. Post-treatment evaluation was performed on eleven of twelve patients with neurosyphilis. All seven patients with neurosyphilis in whom follow-up spinal fluid analysis was performed (10-36 months after treatment) had resolution of their CSF abnormalities. Six of eleven patients with neurosyphilis had at least a four-fold drop in peripheral RPR titer. Follow-up evaluation was performed on thirteen of seventeen patients with late latent syphilis. Seven of thirteen patients with late latent syphilis had at least a four-fold drop in RPR titer, and five became RPR nonreactive. However, six of thirteen with late syphilis showed no change in RPR titer despite at least three doses of IM benzathine penicillin (6-48 months after treatment).

Comparative Study Human HIV Infections/*COMPLICATIONS *Spinal Puncture Syphilis/CEREBROSPINAL FLUID/COMPLICATIONS/*DRUG THERAPY Syphilis Serodiagnosis ABSTRACT

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