Survival improvement of AIDS-related progressive multifocal leukoencephalopathy in the era of protease inhibitors. Clinical Epidemiology Group. French Hospital Database on HIV.
OBJECTIVE
To estimate the change in survival of patients with AIDS-related progressive multifocal leukoencephalopathy (PML), in relation to the introduction of protease inhibitors (PI).


METHODS
The French Hospital Database on HIV (FHDH) is a prospective cohort of 70 224 HIV-infected subjects. This study included the patients diagnosed with PML between 1 July 1995 and 30 June 1997. PML diagnosis was both presumptive and confirmed. We compared the survival probability according to the diagnosis period (period 1 or 2, before or after introduction of PI in France on 1 April 1996). Cox's model was used to calculate the relative hazards of death according to the antiretroviral regimen.


RESULTS
The study included 246 patients, 109 diagnosed during period 1 and 137 during period 2. In all, 131 patients received an antiretroviral combination that included PI. By 31 December 1997, a total of 131 deaths had been reported. The probability of survival at 6 months for patients from period 2 was nearly twice as high as for patients from period 1 (60.5 versus 34.5%). In comparison with patients receiving no treatment, the risk of death in patients on combination therapy not including PI was reduced by 38% [relative hazard (RH) 0.62, 95% confidence interval (CI) (0.41; 0.95), P = 0.026] and in patients on combination therapy with PI, by 63% [RH 0.37, 95% CI (0.22; 0.64), P = 0.0004].


CONCLUSIONS
This study of a large cohort of patients diagnosed with PML (n = 246), provides evidence that a combination antiretroviral regimen, especially one including PI, confers marked survival benefits.
Tassie
J M
JM
Inserm SC4, Paris, France. tassie@b3e.jussieu.fr
Gasnault
J
J
Bentata
M
M
Deloumeaux
J
J
Boué
F
F
Billaud
E
E
Costagliola
D
D
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors