Clinical, Imaging, and Prognostic Differences of Neurosyphilis in HIV and Non-HIV Individuals

Abstract

Background Neurosyphilis remains an important health issue, particularly in populations at risk like men who have sex with men. Our aim was determining differences in the clinical presentation and neuroimaging findings in HIV-positive and non-HIV neurosyphilis patients. Methods This is a retrospective study that included 30 patients who were classified either as non-HIV (n = 16) or HIV positive (n = 14) during the period 1997–2017 at the Instituto Nacional de Neurología y Neurocirugía. Results The main clinical signs in non-HIV patients were dementia (56%, P = 0.02), dementia plus neuro-ophthalmic alterations (50%, P = 0.01), delirious ideas (62.5%, P = 0.03), and judgment errors (44%, P = 0.02). In contrast, neuro-ophthalmic alterations were predominant in HIV-positive patients (85.7%, P = 0.02) along with pachymeningitis (57.1%, P = 0.021) and optic neuritis (57.1%, P = 0.023), as determined by neuroimaging. No significant differences in the cytochemical characteristics of cerebrospinal fluid were observed. Conclusions Dementia was predominant in non-HIV subjects, whereas neuro-ophthalmic lesions were observed earlier and more frequently in HIV-positive patients. Our results highlight the importance of visual signs in HIV-positive patients as an early manifestation of neurosyphilis, and the relevant role of the cerebrospinal fluid Venereal Disease Research Laboratory test in the evaluation of patients with dementia.