[Clinico-epidemiologic manifestations of progressive multifocal leukoencephalopathy in patients with acquired immunodeficiency syndrome (AIDS)]

Severely immunosuppressed patients, including those with AIDS in advanced stage, can suffer opportunistic infections, between them PML. The purpose of this study is to determine epidemiological, clinical and neuroradiological parameters of HIV infected patients diagnosed of PML.

Retrospective review of clinical histories and clinical as well as radiological characteristics, of seven patients diagnosed of AIDS and PML in the Infectious Diseases Unit of our center between January 1990 and December 1997.

Seven patients out of 1093 HIV infected patients were diagnosed of PML (0.76%). All of them were male, intravenous drug users, with a mean age of 32.1 years. Five patients were diagnosed before 1994. In four cases PML was the first opportunistic infection. The mean survival time was 119 +/- 82.2 days (27-231 days). At the moment of diagnosis four patients (57.1%) showed cerebellar symptoms, three (42.8%) sensory deficits and two (28.5%) cognitive dysfunction. There were multiple neurological symptoms in five cases. The mean CD4 cell count was 63.4 cells/mm3. None of the patients showed other concomitant opportunistic infections neither disturbances of cerebrospinal fluid (CSF). CT and NMR showed typical lesions in frontal lobe and cerebellum in four patients. Other affected areas were occipital and parietal lobe, basal ganglia and brain stem. The diagnosis of PML was established by clinical and neuroradiological criteria in six patients and by autopsy in one patient.

The diagnosis of PML in HIV infected patients can be made by clinical and neuroradiological criteria. In the last years, and probably due to the new antiretroviral agents, it has been observed a decrease of the PML incidence in these patients. Nevertheless its prognosis is still dreadful and at present there is no specific curative treatment.