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Progressive multifocal leukoencephalopathy deaths in the USA, 1979-2005

Krista L Yorita Christensen1, Robert C Holman, Teresa A Hammett

  • 1Division of Viral and Rickettsial Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, GA 30333, USA.

Neuroepidemiology
|July 29, 2010
PubMed
Abstract

Insights

Progressive multifocal leukoencephalopathy (PML) deaths significantly declined after 1996, coinciding with highly active antiretroviral therapy (HAART) becoming standard care. This trend is primarily linked to improved survival rates in HIV-positive individuals receiving HAART.

Area of Science:

  • Neurology
  • Epidemiology
  • Public Health

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a rare, opportunistic neurological disease predominantly affecting immunocompromised individuals.
  • The incidence of PML and associated mortality saw an increase with the rising prevalence of HIV/AIDS.
  • This study examines PML-associated death trends in the context of highly active antiretroviral therapy (HAART).

Purpose of the Study:

  • To analyze recent trends in Progressive Multifocal Leukoencephalopathy (PML)-associated mortality.
  • To investigate the epidemiology of deaths attributed to PML in the United States.
  • To assess the impact of highly active antiretroviral therapy (HAART) on PML mortality rates.

Main Methods:

  • Utilized US national multiple-cause-of-death data from 1979 to 2005.
  • Identified records where PML was listed as a cause of death.
  • Calculated age-adjusted PML-associated death rates, stratified by sex, race, region, and HIV status.

Main Results:

  • PML-associated death rates peaked in the mid-1990s, decreasing from 2.76 to 0.66 deaths per million persons between 1992-1995 and 2002-2005.
  • The decline was most pronounced among PML decedents with HIV, males, and those aged 20-49.
  • A non-significant decline was observed in PML deaths without HIV, with decedents becoming more often female and older.

Conclusions:

  • PML mortality has significantly decreased since 1996, the advent of HAART as standard care in the USA.
  • This reduction is strongly associated with improved survival rates among HIV-positive individuals undergoing HAART.
  • The findings highlight the substantial impact of effective HIV treatment on opportunistic infections like PML.

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