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).
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.
Antinori
Andrea
A
Clinical Department , Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, IRCCS, Roma, Italy. antinori@inmi.it
Cingolani
Antonella
A
Lorenzini
Patrizia
P
Giancola
Maria Letizia
ML
Uccella
Ilaria
I
Bossolasco
Simona
S
Grisetti
Susanna
S
Moretti
Francesca
F
Vigo
Beniamino
B
Bongiovanni
Marco
M
Del Grosso
Bruno
B
Arcidiacono
Maria Irene
MI
Fibbia
Giovanni Carlo
GC
Mena
Maurizio
M
Finazzi
Maria Grazia
MG
Guaraldi
Giovanni
G
Ammassari
Adriana
A
d'Arminio Monforte
Antonella
A
Cinque
Paola
P
De Luca
Andrea
A
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