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Yan Yee Hah, Sae Cheong Yap, SU LING HO, STEPHEN TEOH, Rupesh Vijay Agrawal; A comparison of ocular syphilis phenotypes between HIV-Infected and non-HIV adult patients. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3288.
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© ARVO (1962-2015); The Authors (2016-present)
The incidence of new infection with syphilis is increasing worldwide over the last two decades and notably more common among individuals co-infected with human immunodeficiency virus (HIV). Our aim was to compare the clinical manifestations and characteristics of ocular syphilis among the HIV-positive and HIV-negative patients
A retrospective study was done on patients diagnosed with ocular syphilis at a tertiary referral eye care centre in Singapore between January 2005 and October 2015. Demographic characteristics, clinical presentations, investigations such as syphilis and HIV confirmatory tests, lumbar puncture and their pre- and post-treatment visual outcomes were recorded.
32 eyes of 21 (16 eyes in 11 HIV-positive and 16 eyes in 10 HIV-negative) patients were included. All patients were male, with median age at presentation of 50 years (range 34 – 68 years). None of the HIV-positive patients were on HAART therapy and their CD4 counts were in the range of 53 to 349 cells/ml on presentation. A total of seven eyes had panuveitis and they all occurred in the HIV group, making panuveitis the commonest feature in the HIV group. Acute anterior uveitis was the commonest presentation in the non-HIV group (7/16 eyes) as compared to HIV-positive group (5/16 eyes). There was no significant difference in laterality, as there were equal distributions between the HIV and non-HIV patients. Neurosyphilis was more common in the HIV-positive group (7/9 patients) with detection of syphilitic involvement in the cerebral spinal fluid. The outcome of ocular syphilis post-treatment was generally good with most (23/32 eyes, 71.9%) having good visual acuity of 6/12 or better in the affected eye. A similar distribution of good outcomes in visual acuity was seen in both groups (12 eyes in HIV positive, 11 eyes in HIV negative).
Patients with HIV co-infections presented differently with ocular syphilis from non-HIV patients with higher likelihood of panuveitis and neurosyphilis. The higher rate of neurosyphilis warrants a routine lumbar puncture in all HIV-positive patients presenting with ocular syphilis. Prompt diagnosis and treatment of ocular syphilis can result in good outcomes even in HIV co-infected patients.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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