Epidemiology and prognosis of AIDS-associated progressive multifocal leukoencephalopathy in the HAART era. 2001

A Antinori, and A Ammassari, and M L Giancola, and A Cingolani, and S Grisetti, and R Murri, and L Alba, and B Ciancio, and F Soldani, and D Larussa, and G Ippolito, and A De Luca
National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy. antinori@spallanzani.roma.it

Whereas most AIDS-related neurologic disorders have reduced incidence since HAART therapy was introduced, we find that the incidence of progressive multifocal 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 Investigative Neuro AIDS (IRINA) Study, a prospective multicenter study started in January 2000, which showed that PML was the second most frequently diagnosed neurologic disorder after TE. A similar proportion of cases were found in HAART-naïve and HAART-experienced patients in our experience. PML was more common in the presence of HIV RNA > 500 copies/ml. Most of the cases occurring in HAART-exposed patients developed within the first 6 months of therapy. As others have reported, we find a prolonged survival in PML subjects prescribed 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 disorder in our study (P = 0.0005). Our findings also confirm that CSF JCV DNA burden 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 associated with a better neurologic outcome and a longer survival.

UI MeSH Term Description Entries
D007968 Leukoencephalopathy, Progressive Multifocal An opportunistic viral infection of the central nervous system associated with conditions that impair cell-mediated immunity (e.g., ACQUIRED IMMUNODEFICIENCY SYNDROME and other IMMUNOLOGIC DEFICIENCY SYNDROMES; HEMATOLOGIC NEOPLASMS; IMMUNOSUPPRESSION; and COLLAGEN DISEASES). The causative organism is JC Polyomavirus (JC VIRUS) which primarily affects oligodendrocytes, resulting in multiple areas of demyelination. Clinical manifestations include DEMENTIA; ATAXIA; visual disturbances; and other focal neurologic deficits, generally progressing to a vegetative state within 6 months. (From Joynt, Clinical Neurology, 1996, Ch26, pp36-7) Encephalitis, JC Polyomavirus,Progressive Multifocal Leukoencephalopathy,JC Polyomavirus Encephalopathy,Encephalopathies, JC Polyomavirus,Encephalopathy, JC Polyomavirus,JC Polyomavirus Encephalitis,Leukoencephalopathies, Progressive Multifocal,Multifocal Leukoencephalopathies, Progressive,Multifocal Leukoencephalopathy, Progressive,Progressive Multifocal Leukoencephalopathies
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D012042 Registries The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. Parish Registers,Population Register,Parish Register,Population Registers,Register, Parish,Register, Population,Registers, Parish,Registers, Population,Registry
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000163 Acquired Immunodeficiency Syndrome An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive T-lymphocyte count under 200 cells/microliter or less than 14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as defined by the CDC in 1993. AIDS,Immunodeficiency Syndrome, Acquired,Immunologic Deficiency Syndrome, Acquired,Acquired Immune Deficiency Syndrome,Acquired Immuno-Deficiency Syndrome,Acquired Immuno Deficiency Syndrome,Acquired Immuno-Deficiency Syndromes,Acquired Immunodeficiency Syndromes,Immuno-Deficiency Syndrome, Acquired,Immuno-Deficiency Syndromes, Acquired,Immunodeficiency Syndromes, Acquired,Syndrome, Acquired Immuno-Deficiency,Syndrome, Acquired Immunodeficiency,Syndromes, Acquired Immuno-Deficiency,Syndromes, Acquired Immunodeficiency
D015994 Incidence The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from PREVALENCE, which refers to all cases in the population at a given time. Attack Rate,Cumulative Incidence,Incidence Proportion,Incidence Rate,Person-time Rate,Secondary Attack Rate,Attack Rate, Secondary,Attack Rates,Cumulative Incidences,Incidence Proportions,Incidence Rates,Incidence, Cumulative,Incidences,Person time Rate,Person-time Rates,Proportion, Incidence,Rate, Attack,Rate, Incidence,Rate, Person-time,Rate, Secondary Attack,Secondary Attack Rates
D017088 AIDS-Related Opportunistic Infections Opportunistic infections found in patients who test positive for human immunodeficiency virus (HIV). The most common include PNEUMOCYSTIS PNEUMONIA, Kaposi's sarcoma, cryptosporidiosis, herpes simplex, toxoplasmosis, cryptococcosis, and infections with Mycobacterium avium complex, Microsporidium, and Cytomegalovirus. HIV-Related Opportunistic Infections,Opportunistic Infections, AIDS-Related,Opportunistic Infections, HIV-Related,AIDS Related Opportunistic Infections,AIDS-Related Opportunistic Infection,HIV Related Opportunistic Infections,HIV-Related Opportunistic Infection,Infection, HIV-Related Opportunistic,Infections, HIV-Related Opportunistic,Opportunistic Infection, AIDS-Related,Opportunistic Infection, HIV-Related,Opportunistic Infections, AIDS Related,Opportunistic Infections, HIV Related
D023241 Antiretroviral Therapy, Highly Active Drug regimens, for patients with HIV INFECTIONS, that aggressively suppress HIV replication. The regimens usually involve administration of three or more different drugs including a protease inhibitor. Combination Antiretroviral Therapy,HAART,Highly Active Antiretroviral Therapy,Antiretroviral Therapies, Combination,Antiretroviral Therapy, Combination,Combination Antiretroviral Therapies,Therapies, Combination Antiretroviral,Therapy, Combination Antiretroviral

Related Publications

A Antinori, and A Ammassari, and M L Giancola, and A Cingolani, and S Grisetti, and R Murri, and L Alba, and B Ciancio, and F Soldani, and D Larussa, and G Ippolito, and A De Luca
February 1999, Neurology,
A Antinori, and A Ammassari, and M L Giancola, and A Cingolani, and S Grisetti, and R Murri, and L Alba, and B Ciancio, and F Soldani, and D Larussa, and G Ippolito, and A De Luca
April 2008, Journal of neurology,
A Antinori, and A Ammassari, and M L Giancola, and A Cingolani, and S Grisetti, and R Murri, and L Alba, and B Ciancio, and F Soldani, and D Larussa, and G Ippolito, and A De Luca
April 2005, Acta neuropathologica,
A Antinori, and A Ammassari, and M L Giancola, and A Cingolani, and S Grisetti, and R Murri, and L Alba, and B Ciancio, and F Soldani, and D Larussa, and G Ippolito, and A De Luca
August 2005, AIDS patient care and STDs,
A Antinori, and A Ammassari, and M L Giancola, and A Cingolani, and S Grisetti, and R Murri, and L Alba, and B Ciancio, and F Soldani, and D Larussa, and G Ippolito, and A De Luca
March 1992, Nederlands tijdschrift voor geneeskunde,
A Antinori, and A Ammassari, and M L Giancola, and A Cingolani, and S Grisetti, and R Murri, and L Alba, and B Ciancio, and F Soldani, and D Larussa, and G Ippolito, and A De Luca
August 1991, AIDS (London, England),
A Antinori, and A Ammassari, and M L Giancola, and A Cingolani, and S Grisetti, and R Murri, and L Alba, and B Ciancio, and F Soldani, and D Larussa, and G Ippolito, and A De Luca
July 1990, JAMA,
A Antinori, and A Ammassari, and M L Giancola, and A Cingolani, and S Grisetti, and R Murri, and L Alba, and B Ciancio, and F Soldani, and D Larussa, and G Ippolito, and A De Luca
January 2000, Folia neuropathologica,
A Antinori, and A Ammassari, and M L Giancola, and A Cingolani, and S Grisetti, and R Murri, and L Alba, and B Ciancio, and F Soldani, and D Larussa, and G Ippolito, and A De Luca
January 2005, CNS drugs,
A Antinori, and A Ammassari, and M L Giancola, and A Cingolani, and S Grisetti, and R Murri, and L Alba, and B Ciancio, and F Soldani, and D Larussa, and G Ippolito, and A De Luca
January 2020, Revista da Sociedade Brasileira de Medicina Tropical,
Copied contents to your clipboard!