AEGiS-Glasgow [PL9.5] HIV and syphilis: when to perform a lumbar puncture?

Seventh International Congress on Drug Therapy in HIV Infection

Glasgow, UK - 14-17 November 2004

[PL9.5] HIV and syphilis: when to perform a lumbar puncture?

Int Cong Drug Therapy HIV 2004 Nov 14-18;7:Abstract No. PL9.5

A. Libois¹, S. De Wit¹, B. Poll¹, M. Hildebrand¹, E. Florence², M. Vandenbruaene², F. Garcia³, A. Del Rio⁴, P. Sanchez⁵, E. Negredo⁶, J.M. Gatell³, N. Clumeck¹
¹CHU Saint-Pierre, Belgium, Brussels; ²Inst.of Tropical Medicine, Antwerp, Belgium; ³Hosp. Clínic, Spain; ⁴Centro Medico Delfos; ⁵Hosp. del mar; ⁶Hosp. Germans Trias i Pujol, Barcelona, Spain

HIV+ patients (P) with syphilis (S) are considered to be at increased risk for neuroS (NS). Whether this should prompt to systematic lumbar puncture (LP) remains controversial. This study aims to establish whether it is possible to optimize the use of LP by defining specific situations in which it should be performed.

Review of 97 cases of HIV+ P with a reactive treponemal test that underwent a LP. Diagnosis of NS was based on:CSF WBC count≥20/µl and/or a reactive CSF-VDRL and/or a positive TPHA index. Univariate and multivariate analysis were made to identify the risk factors for NS.

Of the 97 cases, 21 had NS. Of these, 8 had neurological manifestations. Among the 21 P, 14 had CSF WBC count ≥20/µl, 6 a reactive CSF-VDRL and 1 a positive TPHA index. All the 13 neurologically asymptomatic patients had a serum RPR≥1/32. Age and female sex were associated with NS (p=0.048, p=0.0361 respectively). CD4, neurological and cutaneous manifestations were not. After controlling for sex, age and neurological manifestations, log₂RPR was associated with NS (p=0.0138). In order to evaluate the risk of NS in P without neurological manifestations, a model linking log₂RPR and risk of NS was built. This model shows that risk increases gradually with log₂RPR. P with RPR≥1/32 are more likely to develop NS (p=0,006).

LP is indicated in HIV+ P with early or late S and neurological manifestations or a RPR≥1/32. The identification of P with high risk of NS would allow to decrease the indication of LP, aiming an optimal use of medical resources.

SESSION 9: HIV-RELATED INFECTIONS, CO-INFECTIONS AND MALIGNANCIES

2004-11-14
PL9.5

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