title: Epidemiology and prognosis of AIDS-associated progressive multifocal leukoencephalopathy in the HAART era.
abstract: Whereas most AIDS-related neurologic disorders have reduced incidence since HAART therapy was introduced, we find that the incidence of progressive multifocal leukoencephalopathy (PML) did not significantly differ between the pre-HAART and the HAART period (OR 0.78; 95% CI 0.41-1.50). These findings were confirmed by the preliminary results of the Italian Register Investigative Neuro AIDS (IRINA) Study, a prospective multicenter study started in January 2000, which showed that PML was the second most frequently diagnosed neurologic disorder after TE. A similar proportion of cases were found in HAART-naïve and HAART-experienced patients in our experience. PML was more common in the presence of HIV RNA > 500 copies/ml. Most of the cases occurring in HAART-exposed patients developed within the first 6 months of therapy. As others have reported, we find a prolonged survival in PML subjects prescribed HAART (245 days in the group treated with HAART versus 66 days in the group not treated with HAART; P at log rank = 0.001). However despite the survival benefit, AIDS-associated PML still has a serious prognosis. In fact, PML had the lowest 1-year survival probability of any cerebral disorder in our study (P = 0.0005). Our findings also confirm that CSF JCV DNA burden at baseline is a useful prognostic indicator with a threshold of 4.7 log(10) JCV copies/ml (P at log rank = 0.01) in our experience. CSF JCV DNA load at 4 weeks of follow-up and clearance of JCV-DNA from CSF are associated with a better neurologic outcome and a longer survival.
authors.affiliation: National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy. antinori@spallanzani.roma.it
authors.forename: A
authors.initials: A
authors.lastname: Antinori
authors.forename: A
authors.initials: A
authors.lastname: Ammassari
authors.forename: M L
authors.initials: ML
authors.lastname: Giancola
authors.forename: A
authors.initials: A
authors.lastname: Cingolani
authors.forename: S
authors.initials: S
authors.lastname: Grisetti
authors.forename: R
authors.initials: R
authors.lastname: Murri
authors.forename: L
authors.initials: L
authors.lastname: Alba
authors.forename: B
authors.initials: B
authors.lastname: Ciancio
authors.forename: F
authors.initials: F
authors.lastname: Soldani
authors.forename: D
authors.initials: D
authors.lastname: Larussa
authors.forename: G
authors.initials: G
authors.lastname: Ippolito
authors.forename: A
authors.initials: A
authors.lastname: De Luca
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000401:mortality*; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000401:mortality; D023241:Antiretroviral Therapy, Highly Active; D006801:Humans; D015994:Incidence; D007968:Leukoencephalopathy, Progressive Multifocal / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries