title: Progressive multifocal leukoencephalopathy in patients with human immunodeficiency virus.
abstract: Lesions of progressive multifocal leukoencephalopathy (PML) in patients infected with the human immunodeficiency virus (HIV) often have mononuclear cell infiltrates so intense that they obscure the nature of the lesion. This response may be especially prominent in stereotactic biopsies of contrast-enhancing areas. Of 10 consecutive PML lesions biopsied stereotactically, three were markedly, two were moderately, and five were mildly inflamed. There were few to no enlarged oligodendrocytic nuclei with inclusions in the markedly and moderately inflamed lesions. We investigated all biopsies with immunoperoxidase, DNA in situ hybridization, polymerase chain reaction, and Southern immunoblot methodologies for toxoplasmosis and the following viruses: JC, cytomegalovirus, herpes simplex viruses I and II, and human T-cell lymphotropic viruses I, II, and III. We confirmed the presence of JC virus in each lesion; polymerase chain reaction revealed HIV genome only in one. Inflammatory PML lesions in HIV+ patients do not reflect co-infection with toxoplasmosis or viruses commonly seen in these patients. The mononuclear cells are primarily T lymphocytes. Patients with severely inflamed PML lesions, whether HIV+ or not, often show stabilization of symptoms with or without antiviral treatment and have longer lengths of survival than patients with less inflamed lesions.
authors.affiliation: Department of Pathology, Columbia-Presbyterian Medical Center, New York, NY 10032.
authors.forename: L S
authors.initials: LS
authors.lastname: Hair
authors.forename: G
authors.initials: G
authors.lastname: Nuovo
authors.forename: J M
authors.initials: JM
authors.lastname: Powers
authors.forename: M B
authors.initials: MB
authors.lastname: Sisti
authors.forename: C B
authors.initials: CB
authors.lastname: Britton
authors.forename: J R
authors.initials: JR
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D001483:Base Sequence; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007124:Immunoenzyme Techniques; D007968:Leukoencephalopathy, Progressive Multifocal / Q000150:complications* / Q000276:immunology / Q000382:microbiology; D016131:Lymphocyte Subsets; D008875:Middle Aged; D008969:Molecular Sequence Data; D009693:Nucleic Acid Hybridization; D016133:Polymerase Chain Reaction