Influence of HAART on the clinical course of HIV-1-infected patients with progressive multifocal leukoencephalopathy: results of an observational multicenter study.
BACKGROUND
The aim of this study was to analyze the incidence of new cases, survival of HIV-1-infected patients with progressive multifocal leukoencephalopathy (PML), and the characteristics of PML-associated immune reconstitution inflammatory syndrome (IRIS).


METHODS
Multicenter observational cohort study of all HIV-1-infected patients newly diagnosed of PML in 7 hospitals in Barcelona (Spain) from 2002 to 2006. The annual incidence of PML was calculated. Survival was estimated using the Kaplan-Meier method. IRIS was defined as new onset or rapid worsening of PML shortly after initiation of highly active antiretroviral therapy together with a decline in HIV-1 viral load and rising of CD4 lymphocytes.


RESULTS
Sixty-one new cases of PML were diagnosed. The mean survival time was 15 months [95% confidence interval (CI), 11 to 19]. The Kaplan-Meier estimates of the probability of survival were 47.7% (95% CI, 35 to 59) at 6 months, 38.6% (95% CI, 25 to 51) at 12 months, 35.1% (95% CI, 22 to 48) at 24 months, and 25.1% (95% CI, 10 to 40) at 36 months. IRIS was diagnosed in 14 (23%) cases. Mortality was similar in patients with and without IRIS.


CONCLUSIONS
PML continues to be one of the deadliest opportunistic infections in acquired immunodeficiency syndrome patients. The development of PML-associated IRIS has no influence on prognosis.
Falcó
Vicenç
V
Infectious Disease Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain. vfalco@vhebron.net
Olmo
Montserrat
M
del Saz
Sara Villar
SV
Guelar
Ana
A
Santos
José R
JR
Gutiérrez
Mar
M
Colomer
Daniel
D
Deig
Elisabet
E
Mateo
Gracia
G
Montero
Milagro
M
Pedrol
Enric
E
Podzamczer
Daniel
D
Domingo
Pere
P
Llibre
Josep M
JM
D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D015497:HIV-1; D006801:Humans; D007154:Immune System Diseases / Q000150:complications / Q000401:mortality; D007968:Leukoencephalopathy, Progressive Multifocal / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis