title: The changing landscape of progressive multifocal leukoencephalopathy.
abstract: Progressive multifocal leukoencephalopathy (PML) is a rare but devastating neurologic disease that affects the immunosuppressed population. The etiologic agent is a polyomavirus, JC virus-a double-stranded DNA virus with a high prevalence of infection globally. PML is believed to occur from reactivation of the latent virus infection caused by immunosuppression. After 1980, a dramatic increase in the incidence and prevalence of PML was attributed to the HIV/AIDS pandemic, with a decline noted after the introduction of highly active antiretroviral treatment (HAART). Newer populations are being added to the risk pool for the development of PML with the introduction of biologic agents that target specific arms of the immune system. Natalizumab and efalizumab seem to have the highest risk for the development of PML, although PML can develop with the other biologic agents. As more patients are treated with these agents, effective risk mitigation strategies are needed to prevent PML.
authors: Department of Neurology, University of Kentucky College of Medicine, 740 S. Limestone St., Lexington, KY, 40515, USA.
authors: Sachin
authors: S
authors: Kedar
authors: Joseph R
authors: JR
authors: Berger
references: N Engl J Med. 1982 Dec 2;307(23):1436-8
references: 6290887
references: Neurology. 2010 Oct 12;75(15):1326-32
references: 20938025
references: Microbiol Immunol. 2009 Sep;53(9):496-501
references: 19703243
references: J Neuroimmunol. 2005 May;162(1-2):51-9
references: 15833359
references: Arthritis Rheum. 2009 Dec;60(12):3761-5
references: 19950261
references: J Virol. 1998 Dec;72(12):9918-23
references: 9811728
references: Clin Infect Dis. 2006 Jul 1;43(1):e9-12
references: 16758410
references: J Neurovirol. 2003;9 Suppl 1:38-41
references: 12709870
references: Blood. 2007 Oct 1;110(7):2316-23
references: 17581918
references: J Med Virol. 2010 Mar;82(3):494-504
references: 20087944
references: Lancet Neurol. 2007 May;6(5):431-41
references: 17434098
references: Ann Neurol. 2001 May;49(5):636-42
references: 11357954
references: Mov Disord. 1993;8(1):113-6
references: 8419794
references: J Med Virol. 2003 Sep;71(1):115-23
references: 12858417
references: AIDS. 1992 Aug;6(8):837-41
references: 1418781
references: Ann Neurol. 2010 Sep;68(3):295-303
references: 20737510
references: N Engl J Med. 2005 Aug 25;353(8):770-81
references: 16120857
references: N Engl J Med. 2005 Jul 28;353(4):414-6
references: 15947082
references: N Engl J Med. 2003 Nov 20;349(21):2004-13
references: 14627785
references: Blood. 2009 May 14;113(20):4834-40
references: 19264918
references: Virus Res. 1984 Jan;1(1):25-38
references: 6099652
references: J Infect Dis. 2009 Jan 1;199(1):77-83
references: 19007313
references: J Infect Dis. 2009 Mar 15;199(6):837-46
references: 19434930
references: MAbs. 2009 Nov-Dec;1(6):583-9
references: 20073129
references: Pathol Res Pract. 1993 Mar;189(2):163-73
references: 8321744
references: Lancet. 1971 Jun 19;1(7712):1257-60
references: 4104715
references: J Neurovirol. 1998 Feb;4(1):59-68
references: 9531012
references: J Infect Dis. 1973 Apr;127(4):467-70
references: 4571704
references: Neurol Clin. 1984 May;2(2):299-313
references: 6503939
references: Ann Intern Med. 1987 Jul;107(1):78-87
references: 3296901
references: Neuroradiology. 1997 Feb;39(2):142-4
references: 9045978
references: Ann Neurol. 1985 Apr;17(4):344-9
references: 4004155
references: Acta Neuropathol. 1989;77(4):379-90
references: 2540610
references: Neuroepidemiology. 2010;35(3):178-84
references: 20664291
references: Clin Infect Dis. 2006 Jul 1;43(1):16-24
references: 16758413
references: Lancet Neurol. 2010 Apr;9(4):438-46
references: 20298967
references: J Infect Dis. 1997 Sep;176(3):632-6
references: 9291308
references: Transplantation. 2008 Nov 27;86(10):1474-8
references: 19034021
references: Brain. 1958 Mar;81(1):93-111
references: 13523006
references: Hum Pathol. 1991 Jul;22(7):700-10
references: 2071114
references: Drug Saf. 2010 Nov 1;33(11):969-83
references: 20925435
references: Neurology. 1994 Oct;44(10):1892-900
references: 7936243
references: N Engl J Med. 2009 Sep 10;361(11):1041-3
references: 19741226
references: Expert Rev Neurother. 2010 Dec;10(12):1789-97
references: 21091310
references: Microbiol Immunol. 1982;26(11):1057-64
references: 6300615
references: J Neurovirol. 2003;9 Suppl 1:59-67
references: 12709874
references: Science. 2004 Nov 19;306(5700):1380-3
references: 15550673
references: Arch Virol Suppl. 2004;(18):161-70
references: 15119771