Clinical

Liver involvement common with syphilis in HIV-infected patients

Last Updated: 2009-09-17 14:39:10 -0400 (Reuters Health)

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - In a new study, 76% of HIV-infected patients with syphilis had some degree of liver involvement, and in 20%, hepatitis was the presenting symptom of syphilis, according to findings presented Monday at the Interscience Conference on Antimicrobial Agents and Chemotherapy in San Francisco.

"Our biggest surprise was to find so high an incidence of hepatitis, as well as the liver enzymes elevation being the first and earliest presenting sign of syphilis," lead researcher Dr. Eugene A. Katchman, from Sourasky Medical Center, Tel Aviv, Israel, told Reuters Health. "The incidence of syphilitic hepatitis...is supposed to be low, but actually nobody studied it previously, especially in the era of HIV/AIDS."

Dr. Katchman and his colleagues studied 33 HIV-positive men who have sex with men. The subjects were diagnosed with early syphilis at the researchers' center between January 2000 and April 2009.

In 56% of patients, the disease was mainly cholestatic, while 28% had features of both cholestatic and parenchymal damage. In 16% of patients, hepatocellular impairment was dominant.

One subject with severe hepatocellular damage had profound jaundice, and granulomatous hepatitis was noted on liver biopsy.

Patient age was directly associated with the extent of liver enzyme elevation, but there was no link between immune status, as assessed with CD4+ cell counts, and the degree of liver involvement.

Antibiotic therapy led to symptomatic and biochemical resolution of syphilitic hepatitis in all patients, the researchers report.

The take-home message for clinicians is that early syphilis is a very common cause of abnormal liver function, at least in HIV-positive patients, Dr. Katchman said. Therefore, physicians should "check the patient for other signs of the disease, and sometimes those will appear later."

In the future, Dr. Katchman hopes "to find out if there is any difference in the rate of liver involvement between the HIV-positive and HIV-negative population with early syphilis."