title: Progressive multifocal leukoencephalopathy (PML) associated with HIV Clade C--is not uncommon.
abstract: Progressive multifocal leukoencephalopathy (PML) is a rare, subacute, demyelinating disease of the central nervous system caused by JC virus. Studies of PML from HIV Clade C prevalent countries are scarce. We sought to study the clinical, neuroimaging, and pathological features of PML in HIV Clade C patients from India. This is a prospective cum retrospective study, conducted in a tertiary care Neurological referral center in India from Jan 2001 to May 2012. Diagnosis was considered "definite" (confirmed by histopathology or JCV PCR in CSF) or "probable" (confirmed by MRI brain). Fifty-five patients of PML were diagnosed between January 2001 and May 2012. Complete data was available in 38 patients [mean age 39 ± 8.9 years; duration of illness-82.1 ± 74.7 days). PML was prevalent in 2.8 % of the HIV cohort seen in our Institute. Hemiparesis was the commonest symptom (44.7 %), followed by ataxia (36.8 %). Definitive diagnosis was possible in 20 cases. Eighteen remained "probable" wherein MRI revealed multifocal, symmetric lesions, hypointense on T1, and hyperintense on T2/FLAIR. Stereotactic biopsy (n = 11) revealed demyelination, enlarged oligodendrocytes with intranuclear inclusions and astrocytosis. Immunohistochemistry revelaed the presence of JC viral antigen within oligodendroglial nuclei and astrocytic cytoplasm. No differences in clinical, radiological, or pathological features were evident from PML associated with HIV Clade B. Clinical suspicion of PML was entertained in only half of the patients. Hence, a high index of suspicion is essential for diagnosis. There are no significant differences between clinical, radiological, and pathological picture of PML between Indian and Western countries.
authors.affiliation: National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: M
authors.initials: M
authors.lastname: Netravathi
authors.forename: Anita
authors.initials: A
authors.lastname: Mahadevan
authors.forename: Parthasarathy
authors.initials: P
authors.lastname: Satishchandra
authors.forename: N
authors.initials: N
authors.lastname: Shobha
authors.forename: Pooja
authors.initials: P
authors.lastname: Mailankody
authors.forename: Thennarasu
authors.initials: T
authors.lastname: Kandavel
authors.forename: Saini
authors.initials: S
authors.lastname: Jitender
authors.forename: G
authors.initials: G
authors.lastname: Anantaram
authors.forename: S
authors.initials: S
authors.lastname: Nagarathna
authors.forename: S
authors.initials: S
authors.lastname: Govekar
authors.forename: B V
authors.initials: BV
authors.lastname: Ravikumar
authors.forename: V
authors.initials: V
authors.lastname: Ravi
authors.forename: S K
authors.initials: SK
authors.lastname: Shankar
mesh_terms: D000328:Adult; D002490:Central Nervous System / Q000473:pathology* / Q000821:virology; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000473:pathology* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007194:India; D007577:JC Virus / Q000302:isolation & purification*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D062606:Tertiary Care Centers