{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T04:59:01Z","timestamp":1768625941334,"version":"3.49.0"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,11,7]],"date-time":"2018-11-07T00:00:00Z","timestamp":1541548800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>People living with HIV (<jats:styled-content style=\"fixed-case\">PLWH<\/jats:styled-content>) are at increased risk of asymptomatic neurosyphilis; thus, it has been common practice to perform a lumbar puncture (<jats:styled-content style=\"fixed-case\">LP)<\/jats:styled-content> in all <jats:styled-content style=\"fixed-case\">PLWH<\/jats:styled-content> presenting with syphilis regardless of stage, signs or symptoms. However, this practice varies widely among clinicians. Our objective was to elucidate the number of <jats:styled-content style=\"fixed-case\">LP<\/jats:styled-content>s required to diagnose a single case of asymptomatic neurosyphilis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed an electronic health record (<jats:styled-content style=\"fixed-case\">EHR<\/jats:styled-content>) review of <jats:styled-content style=\"fixed-case\">PLWH<\/jats:styled-content> who were diagnosed with syphilis of any stage over a 10\u2010year period. <jats:styled-content style=\"fixed-case\">EHR<\/jats:styled-content>s were reviewed to determine the number of subjects who had an <jats:styled-content style=\"fixed-case\">LP<\/jats:styled-content> performed, what proportion had neurological signs or symptoms, and whether a diagnosis of neurosyphilis was made at presentation or follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 261 separate episodes of syphilis in 230 subjects, we found the major risk factors for asymptomatic neurosyphilis to be low <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 T\u2010cell count (<jats:italic>P<\/jats:italic> = 0.0007), high rapid plasma reagin (<jats:styled-content style=\"fixed-case\">RPR<\/jats:styled-content>) titre (<jats:italic>P<\/jats:italic> = 0.019) and lack of <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> virological suppression (<jats:italic>P<\/jats:italic> = 0.003). The majority of our subjects (78%) with neurosyphilis presented with central nervous system (<jats:styled-content style=\"fixed-case\">CNS<\/jats:styled-content>) symptoms. We estimate, if standard practice is to perform <jats:styled-content style=\"fixed-case\">LP<\/jats:styled-content> in all patients, that the number needed to test (<jats:styled-content style=\"fixed-case\">NNTT<\/jats:styled-content>) = 38.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This large number of potentially unnecessary <jats:styled-content style=\"fixed-case\">LP<\/jats:styled-content>s, along with heterogeneity of presentation, and the never\u2010nil risk of asymptomatic neurosyphilis should be incorporated into clinical decision\u2010making. The majority of <jats:styled-content style=\"fixed-case\">PLWH<\/jats:styled-content> presenting with a serological diagnosis of syphilis, but no neurological signs or symptoms, do not necessarily require an <jats:styled-content style=\"fixed-case\">LP<\/jats:styled-content> for an evaluation of asymptomatic neurosyphilis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.12677","type":"journal-article","created":{"date-parts":[[2018,11,7]],"date-time":"2018-11-07T09:16:09Z","timestamp":1541582169000},"page":"27-32","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Risk of neurosyphilis in <scp>HIV<\/scp>\u2010infected persons with syphilis lacking signs or symptoms of central nervous system infection"],"prefix":"10.1111","volume":"20","author":[{"given":"L","family":"Rotman","sequence":"first","affiliation":[{"name":"Department of Internal Medicine University of Illinois at Chicago Chicago IL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"X","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Illinois at Chicago Chicago IL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Thompson","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Immunology &amp; International Medicine University of Illinois at Chicago Chicago IL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ME","family":"Mackesy\u2010Amiti","sequence":"additional","affiliation":[{"name":"School of Public Health University of Illinois at Chicago Chicago IL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"LR","family":"Young","sequence":"additional","affiliation":[{"name":"Jesse Brown Veterans Affairs Medical Center Chicago IL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6745-8209","authenticated-orcid":false,"given":"JD","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Illinois at Chicago Chicago IL USA"},{"name":"Division of Infectious Diseases Immunology &amp; International Medicine University of Illinois at Chicago Chicago IL USA"},{"name":"Jesse Brown Veterans Affairs Medical Center Chicago IL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,11,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001412"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6613a1"},{"key":"e_1_2_8_4_1","unstructured":"Available at:https:\/\/www.cdc.gov\/mmwr\/volumes\/66\/wr\/pdfs\/mm6613a1.pdf. 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