Incidence, clinical presentation, and outcome of progressive multifocal leukoencephalopathy in HIV-infected patients during the highly active antiretroviral therapy era: a nationwide cohort study
- PMID: 19007313
- DOI: 10.1086/595299
Incidence, clinical presentation, and outcome of progressive multifocal leukoencephalopathy in HIV-infected patients during the highly active antiretroviral therapy era: a nationwide cohort study
Abstract
Background: Human immunodeficiency virus (HIV) infection predisposes to progressive multifocal leukoencephalopathy (PML). Here, we describe the incidence, presentation, and prognosis of PML in HIV-1-infected patients during the period before highly active antiretroviral therapy (HAART) (1995-1996) and during the early HAART (1997-1999) and late HAART (2000-2006) periods.
Methods: Patients from a nationwide population-based cohort of adult HIV-1-infected individuals were included. We calculated incidence rates of PML and median survival times after diagnosis. We also described neurological symptoms at presentation and follow-up.
Results: Among 4,649 patients, we identified 47 patients with PML. The incidence rates were 3.3, 1.8, and 1.3 cases per 1000 person-years at risk in 1995-1996, 1997-1999, and 2000-2006, respectively. The risk of PML was significantly associated with low CD4(+) cell count, and 47% of cases were diagnosed by means of brain biopsy or polymerase chain reaction analysis for JC virus. The predominant neurological symptoms at presentation were coordination disturbance, cognitive defects, and limb paresis. Thirty-five patients died; the median survival time was 0.4 years (95% confidence interval [CI], 0.0-0.7) in 1995-1996 and 1.8 years (95% CI, 0.6-3.0) in both 1997-1999 and 2000-2006. CD4(+) cell count >50 cells/microL at diagnosis of PML was significantly associated with reduced mortality.
Conclusions: The incidence of PML in HIV-infected patients decreased after the introduction of HAART. Survival after PML remains poor. In the management of PML, the main focus should be on prophylactic measures to avoid immunodeficiency.
Comment in
-
Does contrast enhancement predict survival in progressive multifocal leukoencephalopathy?J Infect Dis. 2009 May 1;199(9):1410-1; author reply 1411-2. doi: 10.1086/597622. J Infect Dis. 2009. PMID: 19358677 No abstract available.
Similar articles
-
Incidence and outcome of progressive multifocal leukoencephalopathy over 20 years of the Swiss HIV Cohort Study.Clin Infect Dis. 2009 May 15;48(10):1459-66. doi: 10.1086/598335. Clin Infect Dis. 2009. PMID: 19348592
-
Clinical Profile and Outcome of Progressive Multifocal Leukoencephalopathy in HIV Infected Indian Patients.J Assoc Physicians India. 2017 Mar;65(3):40-44. J Assoc Physicians India. 2017. PMID: 28462542
-
Prognostic significance of JC virus DNA levels in cerebrospinal fluid of patients with HIV-associated progressive multifocal leukoencephalopathy.Clin Infect Dis. 2005 Mar 1;40(5):738-44. doi: 10.1086/427698. Epub 2005 Feb 1. Clin Infect Dis. 2005. PMID: 15714422
-
Evaluation of progressive multifocal leukoencephalopathy treatments in a Spanish cohort of HIV-infected patients: do protease inhibitors improve survival regardless of central nervous system penetration-effectiveness (CPE) score?HIV Med. 2013 May;14(5):321-5. doi: 10.1111/hiv.12008. Epub 2012 Dec 6. HIV Med. 2013. PMID: 23217049 Review.
-
[Progressive multifocal leukoencephalopathy--epidemiology, clinical pictures, diagnosis and therapy].Brain Nerve. 2007 Feb;59(2):125-37. Brain Nerve. 2007. PMID: 17380777 Review. Japanese.
Cited by
-
Disease course and outcome of 15 monocentrically treated natalizumab-associated progressive multifocal leukoencephalopathy patients.J Neurol Neurosurg Psychiatry. 2013 Oct;84(10):1068-74. doi: 10.1136/jnnp-2013-304897. Epub 2013 Apr 19. J Neurol Neurosurg Psychiatry. 2013. PMID: 23606731 Free PMC article.
-
Inclusion of rituximab in treatment protocols for non-Hodgkin's lymphomas and risk for progressive multifocal leukoencephalopathy.Oncologist. 2010;15(11):1214-9. doi: 10.1634/theoncologist.2010-0098. Epub 2010 Nov 1. Oncologist. 2010. PMID: 21041380 Free PMC article.
-
Opportunistic Neurologic Infections in Patients with Acquired Immunodeficiency Syndrome (AIDS).Curr Neurol Neurosci Rep. 2016 Jan;16(1):10. doi: 10.1007/s11910-015-0603-8. Curr Neurol Neurosci Rep. 2016. PMID: 26747443 Review.
-
Detectable cerebrospinal fluid JCV DNA in late-presenting HIV-positive patients: beyond progressive multifocal leukoencephalopathy?J Neurovirol. 2017 Oct;23(5):763-767. doi: 10.1007/s13365-017-0549-5. Epub 2017 Jul 5. J Neurovirol. 2017. PMID: 28681343
-
Progressive multifocal leukoencephalopathy and the spectrum of JC virus-related disease.Nat Rev Neurol. 2021 Jan;17(1):37-51. doi: 10.1038/s41582-020-00427-y. Epub 2020 Nov 20. Nat Rev Neurol. 2021. PMID: 33219338 Free PMC article. Review.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Research Materials