GIANG MAI THẦN KINH, GIANG MAI MẮT VÀ VIÊM GAN GIANG MAI Ở BỆNH NHÂN NHIỄM HIV ĐIỀU TRỊ TẠI BỆNH VIỆN BỆNH NHIỆT ĐỚI

Abstract

Introduction: The incidence of syphilis was low in the last decade of the 20^th century; however, it has been on the increase since the early 21^st century with the outbreak of the HIV epidemic among gay, bisexual and other men who have sex with men (MSM). The interaction between HIV and syphilis spirochetes also complicates the course of the disease, making it difficult to diagnose, and leading to uncommon clinical manifestations compared to the non-HIVpopulation. We report cases of neurosyphilis, ocular syphilis, and syphilitic hepatitis in HIVpatients to help physicians be more alert to these forms in clinical practice.

Methods: A descriptivecase-series study was conducted at the Hospital for Tropical Diseases.

Results: There were 14 cases of HIV infection included in the study, all of whom were gay men (2/14 patients having sex with men and women) with a median age of 31. Among these, 10/14 cases  were in the AIDS stage. Only 1 case had a history of previous treatment for syphilis. Regarding diagnosis of syphilis, there were 4 cases of neurosyphilis, 1 case of ocular syphilis, 5 cases of syphilitic hepatitis, 2 cases of concurrent neurosyphilis and ocular syphilis, and 2 cases of concurrent neurosyphilis and syphilitic hepatitis. The level of AST and ALT had moderately increased among all 7 cases of syphilitic hepatitis, with median AST 152 U/L, median ALT 85 U/L; while GGT and ALP both increased significantly, with median GGT being 690 U/L, median ALP being 607 U/L. Clinical jaundice (total bilirubin ≥ 50 umol/L) was present in 4/7 cases of syphilitic hepatitis, and there was no case of acute liver failure. CSF changed in 8 cases of neurosyphilis, all of whomhad protein increase > 0.4 g/L, and all these8 patientstested positive for CSF TPHA, but CSF RPR was positive only in 3/8 cases. After penicillin antibiotic treatment, 6/7 cases of syphilis hepatitis improved in liver enzymes and bilirubin (except for 1 case dropping out of treatment). To sum up, except for 1 case of death with concurrent neurosyphilis and tuberculous meningitis and 1 case dropping out of treatment, the remaining 12 patients fully recoveredafter treatment.

Conclusion: For HIV patients with jaundice and/or cholestatic liver enzyme elevation (increased GGT and ALP), syphilis should be taken into consideration. HIVpatients with suspected neurosyphilis should undergo a lumbar puncture to perform VDRL (or RPR) and CSF TPHA test to confirm the diagnosis. Nowadays, intravenous penicillin G is still an effective antibiotic in treating neurosyphilis, ocular syphilis, and syphilitichepatitis.