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Neurologic Manifestations of HIV Infection

TO THE EDITOR: We disagree with Simpson and Tagliati [1], who favor a presumptive diagnosis and empiric treatment of neurosyphilis in patients with HIV infection, neurologic symptoms, and a reactive cerebrospinal profile only when a positive serum VDRL test result is obtained. Patients with HIV infection frequently have false-positive reaginic test results for syphilis. The problem is greater when these patients are intravenous drug users. In these persons, false-positive reaginic results appear in 25% of cases [2]. We found that a reaginic test had a positive predictive value for syphilis of 27% when it was done in a population of HIV-infected patients, 78% of whom were drug users. Seventy-four of 367 (20%) HIV-infected patients studied in our university hospital had a false-positive test result. These results support the recommendation that therapy should not be initiated without confirmation by a treponemic test.