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Published on: December 3, 2019
Evolution of purely infratentorial PML under HAART--negative outcome under rapid immune reconstitution
1Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany. oliver.kastrup@uni-essen.de
Abstract:
Progressive multifocal leukoencephalopathy (PML) caused by the polyomavirus JC is a well-recognised complication of AIDS. Purely infratentorial manifestations are rare. Introduction of highly active antiretroviral therapy (HAART) has been associated with a reduction in morbidity and an improvement in overall survival among HIV-infected individuals. Recently, several reports have described adverse events in patients with PML who begin HAART and show evidence for immune reconstitution. We describe the clinical course of two patients with PML with purely infratentorial manifestation, whose clinical course deteriorated despite the successful introduction of HAART. Possible underlying immunological mechanisms are discussed.
Insights
Progressive multifocal leukoencephalopathy (PML) in AIDS patients can rarely affect only the cerebellum. Some patients on HAART showed clinical deterioration, suggesting complex immune responses in PML.
Area of Science:
- Neurovirology
- Immunology
- Infectious Diseases
Background:
- Progressive multifocal leukoencephalopathy (PML) is a JC polyomavirus-induced demyelinating disease, often seen in advanced HIV/AIDS.
- Purely infratentorial PML presentations are uncommon.
- Highly active antiretroviral therapy (HAART) has improved outcomes in HIV-infected individuals.
Observation:
- This study details two HIV-positive patients with PML presenting solely with infratentorial symptoms.
- Both patients experienced clinical worsening despite successful initiation of HAART.
- Immune reconstitution inflammatory syndrome (IRIS) is a potential factor in PML progression.
Findings:
- HAART introduction did not prevent clinical deterioration in these PML cases.
- The infratentorial localization of PML may influence disease progression.
- Immune system changes during HAART may paradoxically exacerbate PML.
Implications:
- Further research into the immunological mechanisms of PML-IRIS is crucial.
- Clinical monitoring for adverse events in PML patients initiating HAART is essential.
- Understanding PML's varied presentations can guide therapeutic strategies.
