The Treatment of Neurosyphilis in Patients With HIV Infection

To the Editor.  —Recent reports^1,2 suggest that concurrent human immunodeficiency virus (HIV) infection may alter the natural course of syphilis and that patients seropositive for HIV who become infected by Treponema pallidum are prone to develop neurosyphilis. In addition, patients infected with HIV respond abnormally to antigenic stimulation and may fail to develop a typical serological response to syphilis.³ Based on previous experience treating patients with acquired immunodeficiency syndrome (AIDS) and central nervous system toxoplasmosis or cryptococcosis, it has been suggested that "a more aggressive therapy possibly including maintenance therapy" would be beneficial for patients with neurosyphilis associated with HIV infection.¹ We believe that the present evidence to support the need for long-term antisyphilitic therapy for such patients is meager and that some patients, as in the case that follows, may be successfully treated with conventional regimens.

Report of a Case.  —Five months before admission to the