title: JC virus-associated central nervous system diseases in HIV-infected patients in Brazil: clinical presentations, associated factors with mortality and outcome.
abstract: BACKGROUND
  Several presentations of neurologic complications caused by JC virus (JCV) in human immunodeficiency virus (HIV)-infected patients have been described and need to be distinguished from the "classic" form of progressive multifocal leukoencephalopathy (PMl). The objectives of this study were: 1) to describe the spectrum and frequency of presentations of JCV-associated central nervous system (CNS) diseases; 2) identify factors associated with in-hospital mortality of patients with JCV-associated CNS disease; and 3) to estimate the overall mortality of this population.
  
  
  METHODS
  This was a retrospective study of HIV-infected patients admitted consecutively for JCVassociated CNS diseases in a referral teaching center in São Paulo, Brazil, from 2002 to 2007. All patients with laboratory confirmed JCV-associated CNS diseases were included using the following criteria: compatible clinical and radiological features associated with the presence of JCV DNA in the cerebrospinal fluid. JCV-associated CNS diseases were classified as follows: 1) classic PMl; 2) inflammatory PMl; and 3) JC virus granule cell neuronopathy (GCN).
  
  
  RESULTS
  We included 47 cases. JCV-associated CNS diseases were classified as follows: 1) classic PMl: 42 (89%); 2) inflammatory PMl: three (6%); and 3) JC virus GCN: four (9%). Nosocomial pneumonia (p = 0.003), previous diagnosis of HIV infection (p = 0.03), and imaging showing cerebellar and/or brainstem involvement (p = 0.02) were associated with in-hospital mortality. overall mortality during hospitalization was 34%.
  
  
  CONCLUSIONS
  Novel presentations of JCV-associated CNS diseases were observed in our setting; nosocomial pneumonia, previous diagnosis of HIV infection, and cerebellar and/or brainstem involvement were associated with in-hospital mortality; and overall mortality was high.
authors.affiliation: Department of Infectious Diseases, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.
authors.forename: Felipe
authors.initials: F
authors.lastname: Piza
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Fink
authors.forename: Gilberto S
authors.initials: GS
authors.lastname: Nogueira
authors.forename: Claudio S
authors.initials: CS
authors.lastname: Pannuti
authors.forename: Augusto C Penalva de
authors.initials: AC
authors.lastname: Oliveira
authors.forename: José Ernesto
authors.initials: JE
authors.lastname: Vidal
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000401:mortality* / Q000821:virology; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D004279:DNA, Viral / Q000134:cerebrospinal fluid; D005260:Female; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000401:mortality*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D019562:Viral Load
chemical_list: D004279:DNA, Viral