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Continued declining incidence and improved survival of progressive multifocal leukoencephalopathy in HIV/AIDS

J L Casado1, I Corral, J García

  • 1Department of Infectious Diseases, Ramón y Cajal Hospital, 28034, Madrid, Spain, jcasado.hrc@gmail.com.

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
|August 17, 2013
PubMed

Insights

Progressive multifocal leukoencephalopathy (PML) incidence in human immunodeficiency virus (HIV)-infected patients has declined significantly. Improved survival rates are linked to higher CD4+ counts and cerebrospinal fluid (CSF) inflammation.

Area of Science:

  • Neuroscience
  • Infectious Diseases
  • Immunology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a rare, opportunistic infection affecting the central nervous system.
  • In human immunodeficiency virus (HIV)-infected individuals, PML was historically associated with severe immunosuppression and poor prognosis.
  • The advent of highly active antiretroviral therapy (HAART) has altered the epidemiology and clinical course of many opportunistic infections in HIV/acquired immunodeficiency syndrome (AIDS) patients.

Purpose of the Study:

  • To evaluate the changing incidence, causes, and long-term outcomes of PML in HIV-infected patients.
  • To analyze trends in PML diagnosis and survival across different periods of HAART availability.
  • To identify factors associated with improved survival in HIV-associated PML.

Main Methods:

  • Retrospective analysis of 72 acquired immunodeficiency syndrome (AIDS) patients diagnosed with PML between 1996 and 2011.
  • Classification of patients into three diagnostic periods: 1996-2000, 2001-2006, and 2007-2011 (HAART era).
  • Evaluation of incidence rates, CD4+ T-cell counts, cerebrospinal fluid (CSF) profiles, and survival data using statistical analyses, including Cox regression.

Main Results:

  • Overall PML incidence decreased significantly from 14.8 cases/1,000 patient-years in 1996 to 0.8 in 2011.
  • A higher proportion of recent PML cases (64%) occurred in HIV patients not attending clinical visits.
  • Patients diagnosed more recently exhibited higher median CD4+ counts, increased CSF inflammatory profiles, and significantly longer survival rates (1-year survival up to 79% for CD4+ >100 cells/mm³).

Conclusions:

  • The incidence of PML in HIV-infected patients has dramatically declined.
  • Improved long-term survival in HIV-associated PML is associated with higher baseline CD4+ counts and CSF inflammatory markers.
  • Despite declining incidence, PML remains a significant concern, particularly in patients with poor clinical engagement.

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