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[Progressive multifocal leukoencephalopathy in AIDS. Overview and retrospective analysis of 17 patients]
S Happe1, N Lünenborg, C H Rickert
1Klinik und Poliklinik für Neurologie, Westfälische Wilhelms-Universität Münster.
Abstract:
We describe retrospectively the course of 17 AIDS patients with progressive multifocal leukoencephalopathy (PML) and give a review of their clinical symptoms and survival times. The relative frequency of PML in our cohort of AIDS patients was 2.6%. The mean of CD4-positive cells was 80.5 +/- 82.5/microliter. CD4-positive cells were > 200/microliter only in one patient and increased significantly under a combination of three antiretroviral drugs whereas, with the other patients, CD4-positive cells did not increase with a maximum of two antiretroviral drugs. The mean survival time was 6.6 (1.5-20) months and correlated positively with the number of CD4-positive cells. The diagnosis of PML can be regarded as confirmed when JC-virus DNA is detectable in cerebrospinal fluid, typical changes can be seen in MRI and typical clinical symptoms occur. No effective therapy is known to date. Single case reports on therapy with cidofovir, as in one of the cases described here, showed positive results.
Insights
Progressive multifocal leukoencephalopathy (PML) affects 2.6% of AIDS patients, with survival correlating to CD4 cell counts. Combination antiretroviral therapy may improve CD4 counts, but no definitive PML therapy exists.
Area of Science:
- Neuroscience
- Immunology
- Virology
Context:
- Progressive multifocal leukoencephalopathy (PML) is a rare, opportunistic infection affecting the central nervous system.
- PML is strongly associated with advanced human immunodeficiency virus (HIV) infection and low CD4+ T-cell counts.
- The incidence of PML in the context of acquired immunodeficiency syndrome (AIDS) has implications for patient management and prognosis.
Purpose:
- To retrospectively analyze the clinical course, symptoms, and survival times of 17 AIDS patients diagnosed with PML.
- To investigate the relationship between CD4+ cell counts, antiretroviral therapy, and PML progression in this cohort.
- To review diagnostic criteria for PML and discuss current therapeutic options.
Summary:
- The study reviewed 17 AIDS patients with PML, finding its relative frequency to be 2.6%.
- Mean CD4+ cell count was low (80.5/microliter), with significant increases observed only with triple antiretroviral therapy.
- Mean survival time was 6.6 months, positively correlating with CD4+ cell counts. Diagnosis confirmed by JC-virus DNA, MRI, and clinical symptoms.
- No effective therapy is established, though cidofovir showed positive results in a single case.
Impact:
- Highlights the poor prognosis of PML in AIDS patients and the importance of CD4+ T-cell levels.
- Suggests that potent combination antiretroviral therapy may influence CD4+ cell recovery in PML patients.
- Underscores the need for further research into effective treatments for PML in the context of HIV/AIDS.