LETTER
Neurologic Manifestations of HIV Infection
Federico Pulido;
Rafael Rubio; and
J. Ramon Costa
1 June 1995 | Volume 122 Issue 11 | Pages 883-884
TO THE EDITOR:
We disagree with Simpson and Tagliati [1], who favor a presumptive diagnosis and empiric treatment of neurosyphilis in patients with HIV infection, neurologic symptoms, and a reactive cerebrospinal profile only when a positive serum VDRL test result is obtained.
Patients with HIV infection frequently have false-positive reaginic test results for syphilis. The problem is greater when these patients are intravenous drug users. In these persons, false-positive reaginic results appear in 25% of cases [2].
We found that a reaginic test had a positive predictive value for syphilis of 27% when it was done in a population of HIV-infected patients, 78% of whom were drug users. Seventy-four of 367 (20%) HIV-infected patients studied in our university hospital had a false-positive test result.
These results support the recommendation that therapy should not be initiated without confirmation by a treponemic test.
1. Simpson DM, Tagliati M. Neurologic manifestations of HIV infection. Ann Intern Med. 1994; 121:769-85.
2. Pulido F, Rubio R, Salmeron OJ, Castilla V, Carnevali D, Costa JR, et al. Reactividad de las pruebas serologicas para deteccion de sfilis en pacientes infectados por el virus de la immunodeficiencia humana. Med Clin (Barcelona). 1993; 101:365-7.
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