Neurosyphilis among people with and without HIV infection: A Danish nationwide prospective, population-based cohort study 2015-2021

Christina Carolina Steenberg Schnohr; Fie Welling Paulsen; Lykke Larsen; Merete Storgaard; Micha Phill Grønholm Jepsen; Hans Rudolf Lüttichau; Lothar Wiese; Birgitte Rønde Hansen; Jacob Bodilsen; Henrik Nielsen; Anne-Mette Lebech; Lars H Omland

doi:10.1016/j.jinf.2023.03.019

Neurosyphilis among people with and without HIV infection: A Danish nationwide prospective, population-based cohort study 2015-2021

Christina Carolina Steenberg Schnohr, Fie Welling Paulsen, Lykke Larsen, Merete Storgaard, Micha Phill Grønholm Jepsen, Hans Rudolf Lüttichau, Lothar Wiese, Birgitte Rønde Hansen, Jacob Bodilsen, Henrik Nielsen, Anne-Mette Lebech, Lars H Omland^*

^*Corresponding author for this work

4 Citations (Scopus)

Abstract

BACKGROUND: Comparative data on clinical presentation, laboratory characteristics, treatment, and outcome of neurosyphilis (NS) in people living with HIV (PLWH) and NS patients without HIV are scarce.

METHODS: Nationwide, population-based, prospective cohort study on all adults with NS diagnosed between 2015 and 2021 at departments of infectious diseases in Denmark.

RESULTS: We identified 108 patients with NS, which equals a yearly incidence of 0.3/100,000 adults. The median age was 49 years, 85 (79%) were male, 43 (40%) were men having sex with men and 20 (22%) were PLWH. Ninety-five (88%) had early NS, 37 (34%) had ocular or ocular and otogenic NS, and 27 (25%) had symptomatic meningitis. Most common symptoms were visual disturbance (44%), skin rash (40%), fatigue (26%) and chancre (17%). Median CSF leukocyte count was 27 × 106 cells/L. PLWH less often had neurological deficits (p = 0.02). Unfavorable outcome was observed in 23 (21%) at discharge of whom 0 were PLWH (p = 0.01). Among the 88 NS patients without HIV a CSF leukocyte count of ≥ 30 × 106 cells/L was associated with unfavorable outcome (OR = 3.3 (95% confidence interval: 1.1-10.4)).

CONCLUSIONS: PLWH with NS have better outcomes than NS patients without HIV infection.

Original language	English
Journal	Journal of Infection
Volume	86
Issue number	5
Pages (from-to)	439-445
Number of pages	7
ISSN	0163-4453
DOIs	https://doi.org/10.1016/j.jinf.2023.03.019
Publication status	Published - May 2023

Keywords

Adult
Cohort Studies
Denmark/epidemiology
Female
HIV Infections/complications
Humans
Male
Middle Aged
Neurosyphilis/complications
Prospective Studies

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Schnohr, C. C. S., Paulsen, F. W., Larsen, L., Storgaard, M., Jepsen, M. P. G., Lüttichau, H. R., Wiese, L., Hansen, B. R., Bodilsen, J., Nielsen, H., Lebech, A.-M., & Omland, L. H. (2023). Neurosyphilis among people with and without HIV infection: A Danish nationwide prospective, population-based cohort study 2015-2021. Journal of Infection, 86(5), 439-445. https://doi.org/10.1016/j.jinf.2023.03.019

Schnohr, CCS , Paulsen, FW, Larsen, L, Storgaard, M, Jepsen, MPG , Lüttichau, HR, Wiese, L, Hansen, BR, Bodilsen, J, Nielsen, H, Lebech, A-M & Omland, LH 2023, 'Neurosyphilis among people with and without HIV infection: A Danish nationwide prospective, population-based cohort study 2015-2021', Journal of Infection, vol. 86, no. 5, pp. 439-445. https://doi.org/10.1016/j.jinf.2023.03.019

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title = "Neurosyphilis among people with and without HIV infection: A Danish nationwide prospective, population-based cohort study 2015-2021",

abstract = "BACKGROUND: Comparative data on clinical presentation, laboratory characteristics, treatment, and outcome of neurosyphilis (NS) in people living with HIV (PLWH) and NS patients without HIV are scarce.METHODS: Nationwide, population-based, prospective cohort study on all adults with NS diagnosed between 2015 and 2021 at departments of infectious diseases in Denmark.RESULTS: We identified 108 patients with NS, which equals a yearly incidence of 0.3/100,000 adults. The median age was 49 years, 85 (79%) were male, 43 (40%) were men having sex with men and 20 (22%) were PLWH. Ninety-five (88%) had early NS, 37 (34%) had ocular or ocular and otogenic NS, and 27 (25%) had symptomatic meningitis. Most common symptoms were visual disturbance (44%), skin rash (40%), fatigue (26%) and chancre (17%). Median CSF leukocyte count was 27 × 106 cells/L. PLWH less often had neurological deficits (p = 0.02). Unfavorable outcome was observed in 23 (21%) at discharge of whom 0 were PLWH (p = 0.01). Among the 88 NS patients without HIV a CSF leukocyte count of ≥ 30 × 106 cells/L was associated with unfavorable outcome (OR = 3.3 (95% confidence interval: 1.1-10.4)).CONCLUSIONS: PLWH with NS have better outcomes than NS patients without HIV infection.",

keywords = "Adult, Cohort Studies, Denmark/epidemiology, Female, HIV Infections/complications, Humans, Male, Middle Aged, Neurosyphilis/complications, Prospective Studies",

author = "Schnohr, {Christina Carolina Steenberg} and Paulsen, {Fie Welling} and Lykke Larsen and Merete Storgaard and Jepsen, {Micha Phill Gr{\o}nholm} and L{\"u}ttichau, {Hans Rudolf} and Lothar Wiese and Hansen, {Birgitte R{\o}nde} and Jacob Bodilsen and Henrik Nielsen and Anne-Mette Lebech and Omland, {Lars H}",

year = "2023",

month = may,

doi = "10.1016/j.jinf.2023.03.019",

language = "English",

volume = "86",

pages = "439--445",

journal = "Journal of Infection",

issn = "0163-4453",

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}

TY - JOUR

T1 - Neurosyphilis among people with and without HIV infection

T2 - A Danish nationwide prospective, population-based cohort study 2015-2021

AU - Schnohr, Christina Carolina Steenberg

AU - Paulsen, Fie Welling

AU - Larsen, Lykke

AU - Storgaard, Merete

AU - Jepsen, Micha Phill Grønholm

AU - Lüttichau, Hans Rudolf

AU - Wiese, Lothar

AU - Hansen, Birgitte Rønde

AU - Bodilsen, Jacob

AU - Nielsen, Henrik

AU - Lebech, Anne-Mette

AU - Omland, Lars H

PY - 2023/5

Y1 - 2023/5

N2 - BACKGROUND: Comparative data on clinical presentation, laboratory characteristics, treatment, and outcome of neurosyphilis (NS) in people living with HIV (PLWH) and NS patients without HIV are scarce.METHODS: Nationwide, population-based, prospective cohort study on all adults with NS diagnosed between 2015 and 2021 at departments of infectious diseases in Denmark.RESULTS: We identified 108 patients with NS, which equals a yearly incidence of 0.3/100,000 adults. The median age was 49 years, 85 (79%) were male, 43 (40%) were men having sex with men and 20 (22%) were PLWH. Ninety-five (88%) had early NS, 37 (34%) had ocular or ocular and otogenic NS, and 27 (25%) had symptomatic meningitis. Most common symptoms were visual disturbance (44%), skin rash (40%), fatigue (26%) and chancre (17%). Median CSF leukocyte count was 27 × 106 cells/L. PLWH less often had neurological deficits (p = 0.02). Unfavorable outcome was observed in 23 (21%) at discharge of whom 0 were PLWH (p = 0.01). Among the 88 NS patients without HIV a CSF leukocyte count of ≥ 30 × 106 cells/L was associated with unfavorable outcome (OR = 3.3 (95% confidence interval: 1.1-10.4)).CONCLUSIONS: PLWH with NS have better outcomes than NS patients without HIV infection.

AB - BACKGROUND: Comparative data on clinical presentation, laboratory characteristics, treatment, and outcome of neurosyphilis (NS) in people living with HIV (PLWH) and NS patients without HIV are scarce.METHODS: Nationwide, population-based, prospective cohort study on all adults with NS diagnosed between 2015 and 2021 at departments of infectious diseases in Denmark.RESULTS: We identified 108 patients with NS, which equals a yearly incidence of 0.3/100,000 adults. The median age was 49 years, 85 (79%) were male, 43 (40%) were men having sex with men and 20 (22%) were PLWH. Ninety-five (88%) had early NS, 37 (34%) had ocular or ocular and otogenic NS, and 27 (25%) had symptomatic meningitis. Most common symptoms were visual disturbance (44%), skin rash (40%), fatigue (26%) and chancre (17%). Median CSF leukocyte count was 27 × 106 cells/L. PLWH less often had neurological deficits (p = 0.02). Unfavorable outcome was observed in 23 (21%) at discharge of whom 0 were PLWH (p = 0.01). Among the 88 NS patients without HIV a CSF leukocyte count of ≥ 30 × 106 cells/L was associated with unfavorable outcome (OR = 3.3 (95% confidence interval: 1.1-10.4)).CONCLUSIONS: PLWH with NS have better outcomes than NS patients without HIV infection.

KW - Adult

KW - Cohort Studies

KW - Denmark/epidemiology

KW - Female

KW - HIV Infections/complications

KW - Humans

KW - Male

KW - Middle Aged

KW - Neurosyphilis/complications

KW - Prospective Studies

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U2 - 10.1016/j.jinf.2023.03.019

DO - 10.1016/j.jinf.2023.03.019

M3 - Journal article

C2 - 36967087

SN - 0163-4453

VL - 86

SP - 439

EP - 445

JO - Journal of Infection

JF - Journal of Infection

IS - 5

ER -

Neurosyphilis among people with and without HIV infection: A Danish nationwide prospective, population-based cohort study 2015-2021

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