Expression of CXCL2 in the Serum and Cerebrospinal Fluid of Patients with HIV and Syphilis or Neurosyphilis
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Expression of CXCL2 in the Serum and Cerebrospinal Fluid of Patients with HIV and Syphilis or Neurosyphilis Hung-Chin Tsai,1,2,4 Shin-Yu Ye,3 Susan Shin-Jung Lee,1,2 Shue-Ren Wann,1,2 and Yao-Shen Chen1,2,4
Abstract—The potential mechanisms for blood–brain barrier damage and the diagnosis of neurosyphilis in HIV patients co-infected with syphilis (HIV-S) are unclear. The aim of the study was to determine the expression of CXCL2 in the serum and cerebrospinal fluid (CSF) of HIV-S patients. A total of 34 HIV patients and 7 controls were enrolled in a HIV clinical cohort for diagnosis of neurosyphilis in Taiwan. Serum and CSF concentrations of CXCL2 were determined by ELISA. Neurosyphilis was defined as a CSF white blood cell count of ≧20 cells/μl or a reactive CSF Venereal Disease Research Laboratory (VDRL). Demographics and medical histories were collected. All the patients with HIV-S were males. Most (80 %) had sex with men (MSM) and serum rapid plasma reagin (RPR) titers of ≧1:32. The medium age was 37 (range 21–68)years. The medium CD4 T cell counts at the time of the diagnosis of syphilis were 299 (range 92–434)cells/μl. Eight patients (24 %) had neurosyphilis based on a reactive CSF VDRL test (n=5) or increased CSF white blood cell counts of ≧20 cells/μl (n=3). The concentrations of CSF CXCL2 were significantly higher in patients with HIV and neurosyphilis as compared to HIV with syphilis, HIV, and controls (p=0.012). There were no significant differences in serum concentrations between the four groups. There was a correlation between CSF CXCL2 concentrations with neurosyphilis (p=0.017), CSF white blood cell count (p=0.001), and CSF protein levels (p=0.005). The CSF level of CXCL2 can be used to distinguish those with or without neurosyphilis in HIV infected patients. KEY WORDS: acquire immunodeficiency syndrome; chemokine; CXCL2; neurosyphilis.
INTRODUCTION Syphilis can significantly decrease the CD4 cells and increase HIV viral load in HIV-infected individuals [1–3]. HIV may alter the presentation, diagnosis, and natural course of syphilis and accelerate progression to neurosyphilis [4]. The diagnosis of neurosyphilis is based on reactive cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL). However, the claimed 1
Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, #386 Ta-Chung 1st Road, Kaohsiung, 813 Taiwan, Republic of China 2 National Yang-Ming University, Taipei, Taiwan, Republic of China 3 Department of Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China 4 To whom correspondence should be addressed at Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, #386 Ta-Chung 1st Road, Kaohsiung, 813 Taiwan, Republic of China. E-mail: [email protected]
sensitivity is around 50 % only [5–7]. More accurate diagnosis of neurosyphilis can avoid inadequate treatment from under diagnosis. Furthermore, the decision to perform a lumbar puncture to diagnose neurosyphilis in patients w
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