TY - JOUR

T1 - Neurosyphilis among people with and without HIV infection

T2 - A Danish nationwide prospective, population-based cohort study 2015–2021

AU - Schnohr, Christina Carolina Steenberg

AU - Paulsen, Fie Welling

AU - Larsen, Lykke

AU - Storgaard, Merete

AU - Jepsen, Micha Phill Grønholm

AU - Lüttichau, Hans Rudolf

AU - Wiese, Lothar

AU - Hansen, Birgitte Rønde

AU - Bodilsen, Jacob

AU - Nielsen, Henrik

AU - Lebech, Anne-Mette

AU - Omland, Lars Haukali

N1 - Publisher Copyright: © 2023 The Authors

PY - 2023

Y1 - 2023

N2 - Background: Comparative data on clinical presentation, laboratory characteristics, treatment, and outcome of neurosyphilis (NS) in people living with HIV (PLWH) and NS patients without HIV are scarce. Methods: Nationwide, population-based, prospective cohort study on all adults with NS diagnosed between 2015 and 2021 at departments of infectious diseases in Denmark. Results: We identified 108 patients with NS, which equals a yearly incidence of 0.3/100,000 adults. The median age was 49 years, 85 (79%) were male, 43 (40%) were men having sex with men and 20 (22%) were PLWH. Ninety-five (88%) had early NS, 37 (34%) had ocular or ocular and otogenic NS, and 27 (25%) had symptomatic meningitis. Most common symptoms were visual disturbance (44%), skin rash (40%), fatigue (26%) and chancre (17%). Median CSF leukocyte count was 27 × 106 cells/L. PLWH less often had neurological deficits (p = 0.02). Unfavorable outcome was observed in 23 (21%) at discharge of whom 0 were PLWH (p = 0.01). Among the 88 NS patients without HIV a CSF leukocyte count of ≥ 30 × 106 cells/L was associated with unfavorable outcome (OR = 3.3 (95% confidence interval: 1.1–10.4)). Conclusions: PLWH with NS have better outcomes than NS patients without HIV infection.

AB - Background: Comparative data on clinical presentation, laboratory characteristics, treatment, and outcome of neurosyphilis (NS) in people living with HIV (PLWH) and NS patients without HIV are scarce. Methods: Nationwide, population-based, prospective cohort study on all adults with NS diagnosed between 2015 and 2021 at departments of infectious diseases in Denmark. Results: We identified 108 patients with NS, which equals a yearly incidence of 0.3/100,000 adults. The median age was 49 years, 85 (79%) were male, 43 (40%) were men having sex with men and 20 (22%) were PLWH. Ninety-five (88%) had early NS, 37 (34%) had ocular or ocular and otogenic NS, and 27 (25%) had symptomatic meningitis. Most common symptoms were visual disturbance (44%), skin rash (40%), fatigue (26%) and chancre (17%). Median CSF leukocyte count was 27 × 106 cells/L. PLWH less often had neurological deficits (p = 0.02). Unfavorable outcome was observed in 23 (21%) at discharge of whom 0 were PLWH (p = 0.01). Among the 88 NS patients without HIV a CSF leukocyte count of ≥ 30 × 106 cells/L was associated with unfavorable outcome (OR = 3.3 (95% confidence interval: 1.1–10.4)). Conclusions: PLWH with NS have better outcomes than NS patients without HIV infection.

KW - Antibiotic therapy

KW - HIV

KW - Neurosyphilis

KW - Syphilis

U2 - 10.1016/j.jinf.2023.03.019

DO - 10.1016/j.jinf.2023.03.019

M3 - Journal article

C2 - 36967087

AN - SCOPUS:85151491732

VL - 86

SP - 439

EP - 445

JO - Journal of Infection

JF - Journal of Infection

SN - 0163-4453

IS - 5

ER -