Progressive Multifocal Leukoencephalopathy

Abstract

Whereas most AIDS-related neurologic disorders have reduced incidence since HAART therapy was introduced, we nd that the incidence of progressive multifocal leukoencephalopathy (PML) did not signi cantly differ between the pre-HAART and the HAART period (OR 0.78; 95% CI 0.41-1.50). These ndings were con rmed 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-nave 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 rst 6 months of therapy. As others have reported, we nd 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 bene t, 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 ndings also con rm that CSF JCV DNA burden at baseline is a useful prognostic indicator with a threshold of 4.7 log10 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. Journal of NeuroVirology (2001) 7, 323-328.