Clinical characteristics of neurosyphilis in people with and without HIV infection: a stratified analysis by symptom status

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BACKGROUND: Neurosyphilis (NS) is experiencing a resurgence globally, particularly with higher incidence rates among people living with HIV (PLWH). However, due to the diversity of symptoms associated with NS, especially among PLWH, the diagnosis and treatment of NS still present certain challenges. METHODS: We retrospectively analyzed data from the clinical records of NS patients between December 2016 and December 2022 in Zhongnan Hospital of Wuhan University and The People's Hospital of Jianyang City. The clinical and laboratory data were collected among PLWH and HIV-negative patients. RESULTS: A total of 80 patients (53 PLWH and 27 HIV-negative patients) were included in the study. The median age of PLWH was 32 years (IQR 27-44 years), and 94% of participants were men. Among HIV-negative patients, the median age was 40 years (IQR 32-48 years), 81% were men. A total of 10 (19%) PLWH had a history of syphilis, whereas none of the HIV-negative patients had a history of syphilis. Visual impairment was the most common clinical symptom in PLWH (33%), whereas a decrease of muscle strength was the most common clinical symptom in HIV-negative patients (29%). No differences of laboratory features and outcome were found between these two groups. In both groups, cerebrospinal fluid white blood cell count, cerebrospinal fluid protein concentration and the proportion of participants with abnormal brain imaging were significantly higher in the symptomatic NS patients than that in the asymptomatic NS patients. CONCLUSION: Despite the similar outcome of NS in PLWH and HIV-negative populations, the primary symptoms still differ, highlighting the need for enhanced diagnostic methods, the ability to recognize NS early and provision of timely interventions.

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