Evaluation of non-treponemal tests (VDRL) in the cerebrospinal fluid (CSF) in patients with HIV/AIDS at Instituto de Infectologia Emilio Ribas, São Paulo, Brazil

Abstract

Background: The prevalence of Syphilis has been increasing in the general population and also in patients with HIV/AIDS, and consequently the occurrence of neurosyphilis. Methods & Materials: We reviewed all non-treponemal tests (CSF-VDRL) performed during the period of January, 2013 to September, 2014 and identified 154 patients with neurosyphilis. A total of 135 patients were included in this study after the exclusion of 19 patients due to the lack of viral load and CD4 assessments at the time of the diagnosis of neurosyphilis. We also assessed CSF cytotogy and chemical analysis, HIV RNA (viral load) and CD4 T lymphocyte (CD4) cell count. Results: The analysis showed a total of 135 patients with reactive CSF-VDRL (1:2 a 1:1024). Most patients were men 97.77 (132/135) and the mean age was 43 y (20-64). 39 patients (28.89%) presented CD4 count < 350 cells/mL, of which 19 subjects (48.72%) had HIV viral load below the assay's limit of detection (undetectable) and mean cell count of 9.89 (0-81) whereas 20 subjects (51.28%) presented HIV viral load > 40 copies/mL and mean cell count of 8.96 (0-40). 96 subjects (71.11%) presented CD4 count > 350 cells/mL, of which 83 had undetectable viral load and mean cell count of 7.68 (0-360) and 13 had viral load above the assay's limit of detection and mean cell count of 10.76 (0-55). Conclusion: Our data showed the occurrence of neurosyphilis in 71.1% of HIV/AIDS subjects with CD4 count > 350 cells/mL.