Ocular Syphilis Among HIV-Infected Patients: A Systematic Analysis of the Literature

In the era of highly active antiretroviral therapy (HAART), ocular syphilis among HIV-infected patients "continues to be a problem," wrote the authors. "However, outside of case reports or small case series, little is known about the clinical, laboratory, and treatment outcomes of these patients." The team undertook the current study to examine the literature on HIV-infected patients and determine the results of treatment.

The researchers conducted a systematic review of cases series and case reports among HIV-infected patients with ocular syphilis. They excluded reviews, reports in languages other than English, and reports before 1980. They evaluated the effect of CD4 count and virological suppression on clinical manifestations and diagnostic laboratory values.

The literature review identified 101 HIV-positive individuals. In 52 percent of cases, ocular syphilis led to the HIV diagnosis, including patients with CD4 cell counts above 200 cells/mm3. Posterior uveitis was significantly more common in patients with CD4 counts below 200 cells/mm3 (P=0.002). Three individuals with confirmed ocular syphilis tested negative on non-treponemal tests. Following intravenous treatment with penicillin or ceftriaxone, 97 percent of patients with visual impairment improved.

"Non-treponemal tests may be negative in HIV-infected patients with ocular syphilis," the authors concluded. "Ocular syphilis remains an important clinical manifestation that can lead to initial HIV diagnosis."

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