Progressive multifocal leukoencephalopathy deaths in the USA, 1979-2005.
BACKGROUND
Progressive multifocal leukoencephalopathy (PML) is a neurological disease most often seen among immunosuppressed patients. The incidence of PML increased with an increasing incidence of HIV/AIDS. We describe recent trends and the epidemiology of PML-associated death in the era of highly active antiretroviral therapy (HAART).


METHODS
National multiple-cause-of-death data for the USA were used to identify records with PML listed as a cause of death during 1979-2005. Age-adjusted PML-associated death rates were calculated overall and by sex, race, region and HIV status.


RESULTS
The PML-associated death rates peaked in the mid-1990s and decreased from 2.76 deaths per 1 million persons in 1992-1995 to 0.66 in 2002-2005. This decrease was mainly due to a decreasing death rate among PML decedents with HIV diagnosis, males and those aged 20-49 years at death. A decline in death rate was also seen among PML decedents without HIV diagnosis, although this trend was not significant. Decedents in the latter time period were more often female, and older. The proportion of HIV-associated deaths from PML decreased between 1992-1995 (1.4%) and 2002-2005 (1.0%).


CONCLUSIONS
PML mortality has decreased significantly since 1996 when HAART became the standard of care in the USA. This decline likely reflects increased survival among HIV-positive persons who receive HAART.
Christensen
Krista L Yorita
KL
Division of Viral and Rickettsial Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, GA 30333, USA.
Holman
Robert C
RC
Hammett
Teresa A
TA
Belay
Ermias D
ED
Schonberger
Lawrence B
LB
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D006323:Heart Arrest / Q000453:epidemiology; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007968:Leukoencephalopathy, Progressive Multifocal / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology; D012131:Respiratory Insufficiency / Q000453:epidemiology; D017678:Sex Distribution; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D055815:Young Adult; D001741:Black or African American