Objective To describe the clinical course and prognosis of ocular syphilis in patients infected with HIV-1 in the antiretroviral therapy (ART) era.
Methods We conducted a single-centre retrospective chart review of ocular syphilis in patients infected with HIV-1 diagnosed between August 1997 and July 2015. The prognosis of best-corrected visual acuity (BCVA) was analysed.
Results The study subjects were 30 eyes of 20 men who had sex with men (MSM) (median age, 41). Loss of vision and posterior uveitis were the most common ocular clinical features (43%) and location of inflammation at presentation (50%), respectively. The median baseline BCVA was 0.4 (IQR 0.2–1.2), including three eyes with hand motion. BCVA≤0.4 at diagnosis was significantly associated with posterior uveitis or panuveitis (p=0.044). Seventy-five per cent were treated with intravenous benzylpenicillin and 53% were diagnosed with neurosyphilis. After treatment (median follow-up: 21 months), BCVA improved in 89% of the eyes, including all eyes with hand motion, to a median BCVA of 1.2 (IQR 0.8–1.2). Kaplan–Meier analysis showed that >28 days of ocular symptoms before diagnosis was the only factor associated with poor prognosis of BCVA. Three patients (15%) developed recurrence after treatment.
Conclusions The prognosis of BCVA in HIV-infected patients with ocular syphilis in the ART era was favourable after proper treatment. Having >28 days of ocular symptoms before diagnosis was associated with poor prognosis. Changes in visual acuity in HIV-infected MSM should prompt an immediate assessment for ocular syphilis as delays in diagnosis and therapy can lead to irreversible visual loss.
- PROGNOSTIC INDICATORS
- ANTIRETROVIRAL THERAPY
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Handling editor Jackie A Cassell
Contributors MT, TN and SY did the study design and conception. MT, TN, SY, KT, YK, NK, SO and HG collected the data. MT and TN did the data management and the statistical analyses. All authors participated in revising it critically for important intellectual content, and approved the final version for publication.
Funding This work was supported by Grant-in Aids for AIDS research from the Japanese Ministry of Health, Labour, and Welfare (H23-AIDS-001 and H24-AIDS-003).
Competing interests None declared.
Ethics approval The Human Research Ethics Committee of National Center for Global Health and Medicine (NCGM-G-001623-02).
Provenance and peer review Not commissioned; externally peer reviewed.