Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 8:13:1208155.
doi: 10.3389/fcimb.2023.1208155. eCollection 2023.

Survival and prognostic factors of progressive multifocal leukoencephalopathy in people living with HIV in modern ART era

Rui Jiang  1 , Zichen Song  2 , Li Liu  1 , Xue Mei  3 , Jianjun Sun  1 , Tangkai Qi  1 , Zhenyan Wang  1 , Wei Song  1 , Yang Tang  1 , Junyang Yang  1 , Shuibao Xu  1 , Bihe Zhao  1 , Yinzhong Shen  1 , Renfang Zhang  1 , Jun Chen  1
Affiliations

Survival and prognostic factors of progressive multifocal leukoencephalopathy in people living with HIV in modern ART era

Rui Jiang et al. Front Cell Infect Microbiol. .

Abstract

Background: The incidence of progressive multifocal leukoencephalopathy (PML) in people living with HIV (PLWH) is 2%-4%. Currently, there is no effective therapeutic strategy for the treatment of PML in PLWH, resulting in a mortality of up to 50%. This study aimed to identify risk factors of death and prognostic markers in people living with HIV with PML.

Methods: A retrospective cohort study of AIDS-related PML individuals was conducted from January 1, 2015, to October 1, 2022, in Shanghai, China. PLWH who were diagnosed with PML for the first time were included. Kaplan-Meier curve and Cox regression were used to analyze the survival and its predictors. Levels of inflammatory markers and immune checkpoint inhibitors in blood and cerebrospinal fluid (CSF) were measured in the prestored samples using bead-based multiplex assay Indolamine 2,3-dioxygenase was determined using ELISA.

Results: Twenty of 71 subjects had initiated antiretroviral therapy (ART) before PML onset and no patients discontinued ART during this period. In total, 34 patients (47.9%) had opportunistic infections (OIs), the median CD4+ T cell count was 73.0 (33.0-149.0) cells/μL. The estimated probability of survival at six months was 78% (95% confidential intervals [CIs]:0.63-0.85). OIs, low CD4+ T cell count were associated with lower estimated six-month survival (hazard ratio 8.01, 95% CIs: 1.80-35.00, P=0.006 and 5.01, 95% CIs:1.57-16.03, p=0.007). Indolamine 2,3-dioxygenase activity in CSF of non-survivors group were higher than survivors group (p<0.05).

Conclusions: The survival rate of AIDS-related PML in the modern ART era was higher than the survival rate a decade ago. Low CD4+T cell count, OIs, were all associated with death of individuals with AIDS-related PML. The role of IDO in AIDS-related PML warrant further investigation.

Keywords: HIV/AIDS; HIV/AIDS-related neurological disorders; polyoma virus; prognostic factor; progressive multifocal leukoencephalopathy; survival rate.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Survival curves of PLWH with PML (B) Survival probability of AIDS-related PML patients categorized by OIs. (C) Survival probability of AIDS-related PML patients categorized by CD4+ T cell count at baseline.
See this image and copyright information in PMC

References

    1. Anand P., Hotan G. C., Vogel A., Venna N., Mateen F. J. (2019). Progressive multifocal leukoencephalopathy: A 25-year retrospective cohort study. Neurol. Neuroimmunol Neuroinflamm 6 (6), e618. doi: 10.1212/nxi.0000000000000618 - DOI - PMC - PubMed
    1. Augusto L., Neves N., Reis C., Abreu C., Sarmento A. (2015). Clinical and radiological characterization of progressive multifocal leukoencephalopathy in HIV-infected patients: A retrospective analysis and review of the literature. Acta Med. Port 28, 286–296. doi: 10.20344/amp.5950 - DOI - PubMed
    1. Baer S. L., Colombo R. E., Johnson M. H., Wakade S., Pacholczyk G., Newman-Whitlow C., et al. . (2021). Indoleamine 2,3 dioxygenase, age, and immune activation in people living with HIV. J. Investig. Med. 69, 1238–1244. doi: 10.1136/jim-2021-001794 - DOI - PMC - PubMed
    1. Berenguer J., Miralles P., Arrizabalaga J., Ribera E., Dronda F., Baraia-Etxaburu J., et al. . (2003). Clinical course and prognostic factors of progressive multifocal leukoencephalopathy in patients treated with highly active antiretroviral therapy. Clin. Infect. Dis. 36, 1047–1052. doi: 10.1086/374048 - DOI - PubMed
    1. Berger J. R., Aksamit A. J., Clifford D. B., Davis L., Koralnik I. J., Sejvar J. J., et al. . (2013). PML diagnostic criteria: consensus statement from the AAN Neuroinfectious Disease Section. Neurology 80, 1430–1438. doi: 10.1212/WNL.0b013e31828c2fa1 - DOI - PMC - PubMed

Publication types

MeSH terms