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Progressive multifocal leukoencephalopathy in patients with human immunodeficiency virus
L S Hair1, G Nuovo, J M Powers
1Department of Pathology, Columbia-Presbyterian Medical Center, New York, NY 10032.
Human Pathology
|June 1, 1992
Summary
Inflammation in progressive multifocal leukoencephalopathy (PML) lesions in HIV+ patients is primarily due to T lymphocytes, not co-infections. Higher inflammation correlates with better survival and symptom stabilization in PML patients.
Area of Science:
- Neurology
- Virology
- Immunology
Background:
- Progressive multifocal leukoencephalopathy (PML) lesions in HIV+ patients can exhibit intense mononuclear cell infiltrates, obscuring lesion characteristics.
- This intense inflammation is particularly noted in stereotactic biopsies of contrast-enhancing PML areas.
Purpose of the Study:
- To investigate the nature of inflammatory infiltrates in PML lesions from HIV+ patients.
- To determine if co-infections with other pathogens contribute to the inflammation.
- To correlate inflammation severity with clinical outcomes.
Main Methods:
- Stereotactic biopsies of 10 PML lesions were analyzed.
- Immunoperoxidase, DNA in situ hybridization, PCR, and Southern immunoblot were used to detect JC virus, HIV, and other common opportunistic infections (toxoplasmosis, CMV, HSV I/II, HTLV I/II/III).
Main Results:
- JC virus was confirmed in all lesions.
- HIV genome was detected in only one lesion.
- Inflammation was primarily composed of T lymphocytes, with no evidence of co-infection with toxoplasmosis or other tested viruses.
- Severely inflamed PML lesions were associated with symptom stabilization and longer survival, irrespective of HIV status.
Conclusions:
- Inflammatory PML lesions in HIV+ patients are not typically caused by co-infections with common opportunistic pathogens.
- The mononuclear infiltrates are predominantly T lymphocytes.
- Greater inflammation in PML lesions is a positive prognostic indicator for patient survival and symptom management.