title: Macrophage chemoattractant protein-1 levels in cerebrospinal fluid correlate with containment of JC virus and prognosis of acquired immunodeficiency syndrome--associated progressive multifocal leukoencephalopathy.
abstract: In the highly active antiretroviral therapy (HAART) era, the role of the inflammatory response in acquired immunodeficiency syndrome (AIDS)-related progressive multifocal leukoencephalopathy (PML) remains controversial. In this study, JC virus DNA load and levels of cytokines were determined in cerebrospinal fluid (CSF) from 32 human immunodeficiency virus (HIV)-1-infected patients with confirmed PML who underwent HAART; cytokines were also measured in 12 HIV-positive controls. Predictors of survival were analyzed by Cox's models. Macrophage chemoattractant protein (MCP)-1 levels were significantly higher in PML patients than in controls (mean +/- SD, 2.45 +/- 0.64 versus 1.32 +/- 0.64 log(10) pg/ml, P<.0001). In PML patients, the higher concentration of MCP-1 correlated with lower JC viral load (r=-.405, P=.036). Higher concentrations of MCP-1 in CSF were associated with longer survival on HAART after adjusting for CD4 counts (for each log(10) pg/ml higher, hazard ratio for death 0.28, 95% confidence interval 0.08--1.00). Predictors of shorter survival were lower baseline CD4 counts, higher JCV DNA concentrations, lower Karnofsky, and no prior HAART exposure. These results showed that higher CSF levels of MCP-1, an inflammatory cytokine, were correlated with better prognosis in HAART-treated patients with PML.
authors.affiliation: Istituto di Clinica delle Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Marzocchetti
authors.forename: Antonella
authors.initials: A
authors.lastname: Cingolani
authors.forename: Simona Di
authors.initials: SD
authors.lastname: Giambenedetto
authors.forename: Adriana
authors.initials: A
authors.lastname: Ammassari
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Giancola
authors.forename: Roberto
authors.initials: R
authors.lastname: Cauda
authors.forename: Andrea
authors.initials: A
authors.lastname: Antinori
authors.forename: Andrea De
authors.initials: AD
authors.lastname: Luca
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D018932:Chemokine CCL2 / Q000134:cerebrospinal fluid*; D004279:DNA, Viral / Q000134:cerebrospinal fluid; D005260:Female; D015497:HIV-1; D006801:Humans; D007577:JC Virus / Q000235:genetics / Q000302:isolation & purification*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D011379:Prognosis; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D018932:Chemokine CCL2; D004279:DNA, Viral