Neurocognitive impairment in HIV-infected individuals with previous syphilis

Int J STD AIDS. 2013 May;24(5):351-5. doi: 10.1177/0956462412472827. Epub 2013 Jun 14.

Abstract

Cognitive impairment is common in HIV-infected individuals, as is syphilis. Treponema pallidum, the bacterium that causes syphilis, invades the central nervous system early in disease. We hypothesized that HIV-infected patients with a history of syphilis or neurosyphilis would have more cognitive impairment than HIV-infected individuals without these infections. Eighty-two of 1574 enrollees in CHARTER, a prospective, observational study, had reactive serum rapid plasma reagin (RPR) tests. They were matched to 84 controls with non-reactive RPR by age, gender, ethnicity and HIV risk factor. Participants underwent comprehensive neuropsychological (NP) evaluations. RPR results were confirmed and serum fluorescent treponemal antibody absorption (FTA-ABS) test reactivity determined at a central laboratory. Sera from 101 of 166 participants were FTA-ABS reactive, indicating past or current syphilis. Among the 136 individuals without confounding conditions, compared with patients who had never had syphilis, those with prior syphilis had a greater number of impaired NP test domains (1.90 SD [1.77] versus 1.25 [1.52], P = 0.03), a higher global deficit score (0.47 [0.46] versus 0.31 [0.33], P = 0.03), and more were impaired in the NP learning domain (36 [42.9%] of 84 versus 13 [25.0%] of 52, P = 0.04). These effects of prior syphilis remained after controlling for education and premorbid intelligence.

Keywords: AIDS; HIV; Treponema pallidum; central nervous system; neurocognitive impairment; neurosyphilis; sexually transmitted infection; syphilis.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Case-Control Studies
  • Cognition Disorders / diagnosis
  • Cognition Disorders / epidemiology
  • Cognition Disorders / virology*
  • Female
  • Fluorescent Treponemal Antibody-Absorption Test
  • HIV Infections / complications*
  • HIV Infections / epidemiology
  • HIV Infections / psychology
  • Humans
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Neurosyphilis / blood
  • Neurosyphilis / diagnosis*
  • Neurosyphilis / epidemiology
  • Prospective Studies
  • Syphilis / blood
  • Syphilis / diagnosis*
  • Syphilis / epidemiology
  • Syphilis Serodiagnosis
  • Treponema pallidum / immunology*
  • Treponema pallidum / isolation & purification