title: Clinical epidemiology and survival of progressive multifocal leukoencephalopathy in the era of highly active antiretroviral therapy: data from the Italian Registry Investigative Neuro AIDS (IRINA).
abstract: Human immunodeficiency virus (HIV)-associated progressive multifocal leukoencephalopathy (PML) remains a relevant clinical problem even in the era of highly active antiretroviral therapy (HAART). Aims of the study were to analyze clinical and treatment-related features and the survival probability of PML patients observed within the Italian Registry Investigative Neuro AIDS (IRINA) during a 29-month period of HAART. Intravenous drug use, the presence of focal signs, and the involvement of white matter at neuroradiology increased the risk of having PML. A reduced probability of PML was observed when meningeal signs were reported. Patients starting HAART at PML diagnosis and previously naïve for antiretrovirals showed significantly higher 1-year probability of survival (.58), compared to those continuing HAART (.24), or never receiving HAART (.00). Higher CD4 cell count were associated with a higher survival probability (.45). At multivariate analysis, a younger age, higher CD4, starting HAART at PML diagnosis, the absence of previous acquired immunodeficiency syndrome (AIDS)-defining events, and the absence of a severe neurologic impairment were all associated with a reduced hazard of death. The use of cidofovir showed a trend towards a reduced risk of death.
authors.affiliation: Clinical Department , Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, IRCCS, Roma, Italy. antinori@inmi.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Antinori
authors.forename: Antonella
authors.initials: A
authors.lastname: Cingolani
authors.forename: Patrizia
authors.initials: P
authors.lastname: Lorenzini
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Giancola
authors.forename: Ilaria
authors.initials: I
authors.lastname: Uccella
authors.forename: Simona
authors.initials: S
authors.lastname: Bossolasco
authors.forename: Susanna
authors.initials: S
authors.lastname: Grisetti
authors.forename: Francesca
authors.initials: F
authors.lastname: Moretti
authors.forename: Beniamino
authors.initials: B
authors.lastname: Vigo
authors.forename: Marco
authors.initials: M
authors.lastname: Bongiovanni
authors.forename: Bruno
authors.initials: B
authors.lastname: Del Grosso
authors.forename: Maria Irene
authors.initials: MI
authors.lastname: Arcidiacono
authors.forename: Giovanni Carlo
authors.initials: GC
authors.lastname: Fibbia
authors.forename: Maurizio
authors.initials: M
authors.lastname: Mena
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Finazzi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Guaraldi
authors.forename: Adriana
authors.initials: A
authors.lastname: Ammassari
authors.forename: Antonella
authors.initials: A
authors.lastname: d'Arminio Monforte
authors.forename: Paola
authors.initials: P
authors.lastname: Cinque
authors.forename: Andrea
authors.initials: A
authors.lastname: De Luca
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D023241:Antiretroviral Therapy, Highly Active; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007968:Leukoencephalopathy, Progressive Multifocal / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D016019:Survival Analysis