Characteristics of Brain White Matter Microstructure in HIV Male Patients With Primary Syphilis Co-Infection.

Rui-Li Li,Xing Li,Wen Yu,Yu Qi,Jing Liu,Jiao-Jiao Liu,Yi-Fan Guo,Yuan-Yuan Wang,Xiao-Dong Zhang,Hong-Jun Li,Bo Rao,Wei Wang,Xu-Ze Liu

doi:10.3389/fneur.2021.776818

Abstract

Purpose: To investigate the effect of syphilis infection on the microstructure of white matter (WM) in HIV-infected male patients using diffusion tensor imaging (DTI).Methods: Twenty-seven HIV-infected male patients with current syphilis or a history of syphilis (HIV +/syphilis +), twenty-nine HIV-infected male patients without syphilis co-infection (HIV +/syphilis–), and twenty-nine healthy controls (HC) were enrolled. All participants received DTI, and all patients received comprehensive neuropsychological assessment. Tract-based spatial statistics (TBSS) was adopted to analyze the DTI measures: fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). Correlation analysis was conducted to investigate the relationships between DTI measures and cognitive performance.Results: There were no significant differences in DTI measures between HIV+/syphilis– and HC. Compared with HC, lower FA was found in body of corpus callosum (BCC), splenium of corpus callosum (SCC), genu of corpus callosum (GCC), the bilateral anterior corona radiata (ACR), superior corona radiata (SCR), posterior corona radiata (PCR), and posterior thalamic radiation (PTR) in HIV+/syphilis+ (p < 0.05). Higher RD was found in BCC and SCC (p < 0.05). Compared with HIV+/syphilis–, lower scores were found in complex motor skills (CMS) in HIV+/syphilis+, lower FA was found in BCC, SCC, GCC, the bilateral ACR, SCR, PCR, PTR, cingulate gyrus (CGC), the right inferior fronto-occipital fasciculus (IFO), the retrolenticular part of internal capsule (RLIC), sagittal stratum (SS), external capsule (EC) in HIV+/syphilis+ (p < 0.01). Correlation analysis uncorrected for multiple comparisons showed there was a positive correlation between FA in GCC and CMS, FA in BCC, and CMS in HIV+/syphilis+.Conclusions: Syphilis co-infection can have an additive or synergistic effect on the brain WM in HIV-infected subjects. HIV-infected patients without syphilis should be actively treated to avoid syphilis infection.

Highlights

Human immunodeficiency virus (HIV) can penetrate into the central nervous system (CNS) during the early stage of infection
The inclusion criteria were as follows: [1] the patients with HIV were diagnosed by an enzyme-linked immunosorbent assay and western blot analysis; [2] the patients received T pallidum particle agglutination (TP-PA) and the Rapid Plasma Reagin (RPR); [3] syphilis infection occurred after HIV infection; [4] male; [5] age had to be from 18 to 50 years; [6] the patients underwent a comprehensive neuropsychological assessment and had complete clinical and imaging data
There were two kinds of patients in the HIV+/syphilis+ group: 11 patients had a history of primary syphilis, and 16 patients were diagnosed as primary syphilis

Summary

Introduction

Human immunodeficiency virus (HIV) can penetrate into the central nervous system (CNS) during the early stage of infection. One study showed that viral RNA could be detected in the cerebrospinal fluid (CSF) within as early as 8 days of HIV infection [1]. Syphilis infection caused by the spirochaete bacterium Treponema pallidum has the same group of patients with HIV; the incidence of syphilis is 77 times greater in HIV-infected patients than in the general population [5, 6]. Syphilis infection involves primary syphilis, secondary syphilis, and tertiary syphilis. About 25–40% of infected patients can have “neuroivasion” during infection, especially in the stage of primary syphilis and secondary syphilis. Due to the CSF can clear the infection automatically, people in the stage of primary syphilis and secondary syphilis may not have any CNS symptoms. When CSF fails to clear the infection, neurosyphilis develops [7]

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