Epidemiology and prognosis of AIDS-associated progressive multifocal leukoencephalopathy in the HAART era.
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.
Antinori
A
A
National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy. antinori@spallanzani.roma.it
Ammassari
A
A
Giancola
M L
ML
Cingolani
A
A
Grisetti
S
S
Murri
R
R
Alba
L
L
Ciancio
B
B
Soldani
F
F
Larussa
D
D
Ippolito
G
G
De Luca
A
A
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