Clinical Features and Corrected Factors with Neurosyphilis in HIV/Syphilis Co-Infected Patients Based on Stage of Syphilis

Objective:Neurosyphilis is challenging to diagnose,especially in patients with human immunodeficiency virus(HIV)/syphilis co-infection.The aim of this study was to profile the clinical features of neurosyphilis and evaluate the correlation between neurosyphilis and clinical or laboratory factors among patients with HIV/syphilis co-infection.Methods:We retrospectively analyzed the data of 479 HIV/syphilis co-infected patients examined between August 2009 and September 2018.A multivariate logistic regression model was used to identify factors correlated with neurosyphilis.Results:The overall prevalence of neurosyphilis was 21.7％.The prevalence of neurosyphilis differed among patients with primary(11.1％),secondary(20.1％),and latent syphilis(29.1％).The prevalences of neurosyphilis in patients with serological non-response and serofast patients were 26.1％and 6.3％,respectively,while 12.5％of patients with serological relapse had neurosyphilis.Patients with secondary and latent syphilis had serum rapid plasma reagin(RPR)titers(per unit)of 1.44-fold[95％confidence interval(CI):1.08-1.93,P=0.014]and 2.73-fold(95％CI:1.49-5.00,P=0.001),respectively,which increased the risk of confirmed neurosyphilis.Among patients with latent syphilis,a serum RPR titer of≥1∶32 and peripheral blood CD4 cell count of≤350/mL were significantly associated with neurosyphilis,with adjusted odds ratios of 9.45(95％CI:1.86-48.03,P=0.007)and 3.75(95％CI:1.11-12.66,P=0.033),respectively.Conclusion:A serum RPR titer of≥1∶32 and a peripheral blood CD4 cell count of≤350/mL have predictive value in screening for neurosyphilis among HIV-positive patients with latent syphilis.