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. 2022 Jul-Dec;43(2):156-160.
doi: 10.4103/ijstd.IJSTD_29_18. Epub 2022 Nov 17.

Study of clinical profile and outcomes in progressive multifocal leukoencephalopathy in acquired immunodeficiency syndrome patients in the highly active antiretroviral therapy era - An observational study

Sumit Arora  1 , Faiz M H Ahmad  2 , Rajesh Deshwal  3 , Pradeep Behal  4
Affiliations

Study of clinical profile and outcomes in progressive multifocal leukoencephalopathy in acquired immunodeficiency syndrome patients in the highly active antiretroviral therapy era - An observational study

Sumit Arora et al. Indian J Sex Transm Dis AIDS. 2022 Jul-Dec.

Abstract

Background and objectives: Progressive multifocal leukoencephalopathy (PML) is a viral infection affecting the central nervous system (CNS) seen mostly in advanced human immunodeficiency virus (HIV) infection. There is limited data on the epidemiology and disease course of these patients from India. This study was aimed to determine the frequency of PML in patients with HIV/acquired immunodeficiency syndrome (AIDS) and the clinical presentation and prognosis of these patients.

Materials and methods: The study was conducted at a tertiary care HIV center in New Delhi. Data of 765 patients from our anti-retroviral therapy (ART) clinic during a span of 4 years were retrospectively analyzed and reviewed. The diagnosis was based on the clinical and radiological picture and exclusion of other differential diagnosis by cerebrospinal fluid and serological studies.

Results: Of 765 patients with HIV/AIDS, 12 (1.56%) were diagnosed with PML on the basis of consistent clinical and radiological features after ruling out other differential diagnosis. PML was the initial presentation of HIV infection in 8 (55.5%) patients. 11 (89%) patients had CD4 count <200/μl. Insidious onset focal limb weakness (50%) and dysarthria (50%) were common symptoms. Magnetic resonance imaging of the brain revealed characteristic white matter lesions in all the patients. The estimated median survival was 40 months (95% confidence interval, 23.88-53.19 months).

Interpretation and conclusions: Our results show that PML is associated with high morbidity despite the institution of highly active ART (HAART), but mortality has significantly declined if ART is started early. Key to good response is early diagnosis and HAART.

Keywords: Acquired immunodeficiency syndrome; JC virus; human immunodeficiency virus; progressive multifocal leukoencephalopathy.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
A 47-year-old woman presented with subacute onset progressive weakness of the left upper limb followed by lower limb with visual impairment in the left eye and dysarthria over a period of 4 weeks duration. Magnetic resonance imaging brain shows diffuse bilateral asymmetrical altered signal intensity lesions in the subcortical (arcuate U-fibers) and deep white matter in the right Fronto -parieto- temporal region and left occipital lobe, midbrain superior colliculus, and cerebral peduncles. Lesions were hyperintense on T2 and fluid-attenuated inversion recovery and hypointense on T1 with no mass effect or contrast enhancement.(a) MRI Brain Saggital section T2 weighted image (b) MRI Brain Axial section T2 weighted image
Figure 2
Figure 2
A 48-year-old man presented with subacute progressive cognitive decline and loss of vision. Magnetic resonance imaging revealed asymmetric T2 and fluid-attenuated inversion recovery hyperintensities in deep periventricular white matter in bilateral parietal and left occipital lobes with no mass effect, no contrast enhancement, and no true restriction on diffusion-weighted imaging. (a) MRI Brain Coronal section T2 Weighted image (b) MRI Brain Axial section T2 weighted image
Figure 3
Figure 3
Survival probability of patients with progressive multifocal leukoencephalopathy estimated using the Kaplan–Meier method
See this image and copyright information in PMC

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