Epidemiology and prognosis of AIDS-associated progressive multifocal leukoencephalopathy in the HAART era

Citation
A. Antinori et al., Epidemiology and prognosis of AIDS-associated progressive multifocal leukoencephalopathy in the HAART era, J NEUROVIRO, 7(4), 2001, pp. 323-328
Citations number
29
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Neurosciences & Behavoir
Journal title
JOURNAL OF NEUROVIROLOGY
ISSN journal
1355-0284 → ACNP
Volume
7
Issue
4
Year of publication
2001
Pages
323 - 328
Database
ISI
SICI code
1355-0284(200108)7:4<323:EAPOAP>2.0.ZU;2-A
Abstract
Whereas most AIDS-related neurologic disorders have reduced incidence since HAART therapy was introduced, we find that the incidence of progressive mu ltifocal leukoencephalopathy (PML) did not significantly differ between the pre-HAART and the HAART period (OR 0.78; 95% CI 0.41-1.50). These findings were confirmed by the preliminary results of the Italian Register Investig ative Neuro AIDS (IRINA) Study, a prospective multicenter study started in January 2000, which showed that PML was the second most frequently diagnose d neurologic disorder after TE. A similar proportion of cases were found in HAART-naive and HAART-experienced patients in our experience. PML was more common in the presence of HIV RNA > 500 copies/ml. Most of the cases occur ring in HAART-exposed patients developed within the first 6 months of thera py. As others have reported, we find a prolonged survival in PML subjects p rescribed HAART (245 days in the group treated with HAART versus 66 days in the group not treated with HAART; P at log rank = 0.001). However despite the survival benefit, AIDS-associated PML still has a serious prognosis. In fact, PML had the lowest 1-year survival probability of any cerebral disor der in our study (P = 0.0005). Our findings also confirm that CSF JCV DNA b urden at baseline is a useful prognostic indicator with a threshold of 4.7 log(10) JCV copies/ml (P at log rank = 0.01) in our experience. CSF JCV DNA load at 4 weeks of follow-up and clearance of JCV-DNA from CSF are associa ted with a better neurologic outcome and a longer survival.