CXCL13 as a cerebrospinal fluid marker for neurosyphilis in HIV-infected patients with syphilis.

Abstract

BACKGROUND:

Asymptomatic neurosyphilis is more difficult to diagnose in human immunodeficiency virus (HIV)-infected patients because HIV itself can cause cerebrospinal fluid (CSF) pleocytosis. The proportion of CSF lymphocytes that are B cells is elevated in neurosyphilis, suggesting that the CSF concentration of the B cell chemoattractant, chemokine (C-X-C motif) ligand 13 (CXCL13) concentration may also be elevated.

METHODS:

CSF and blood were collected from 199 HIV-infected patients with syphilis and neurosyphilis. Serum and CSF CXCL13 concentrations were determined.

RESULTS:

Patients with neurosyphilis had higher CSF and serum CXCL13 concentrations compared to patients with syphilis but not neurosyphilis. The odds of having symptomatic neurosyphilis were increased by 2.23-fold for every log increase in CSF CXCL13 concentration and were independent of CSF white blood cell and plasma HIV RNA concentrations, peripheral blood CD4+ T cell count and use of antiretroviral medications. A cut-off of 10 pg/mL CSF CXCL13 had high sensitivity and a cut-off of 250 pg/mL or evidence of intrathecal synthesis of CXCL13 had high specificity for diagnosis of both symptomatic and asymptomatic neurosyphilis. CSF concentrations of CXCL13 declined after treatment for neurosyphilis.

CONCLUSIONS:

CSF CXCL13 concentration may be particularly useful for diagnosis of neurosyphilis in HIV-infected patients because it is independent of CSF pleocytosis and markers of HIV disease.

• Authors: Christina M Marra, Lauren C Tantalo, Sharon K Sahi, Clare L Maxwell, Sheila A Lukehart
• Journal: Sexually transmitted diseases (Sex Transm Dis) Vol. 37 Issue 5 Pg. 283-7 (May 2010) ISSN: 1537-4521 [Electronic] United States
• PMID: 20393380 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Biomarkers
• CXCL13 protein, human
• Cardiolipins
• Chemokine CXCL13
• Phosphatidylcholines
• RNA, Viral
• VDRL antigen
• Cholesterol

Topics

• Adult
• Biomarkers (cerebrospinal fluid)
• Cardiolipins
• Chemokine CXCL13 (cerebrospinal fluid)
• Cholesterol
• Cohort Studies
• Female
• HIV Infections (complications)
• Humans
• Male
• Neurosyphilis (cerebrospinal fluid, diagnosis)
• Phosphatidylcholines
• RNA, Viral
• Reverse Transcriptase Polymerase Chain Reaction
• Spinal Puncture
• Syphilis (complications, diagnosis)
• Treponema pallidum (immunology)