Clinical Profile and Outcome of Progressive Multifocal Leukoencephalopathy in HIV Infected Indian Patients
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Published on: October 6, 2015
Vipul Shah1, Harsh Toshniwal2, Manoj Shevkani2
1Consultant, Shrey Hospital, Ahmedabad, Gujarat.
Background And Objective:
Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease of the Central nervous system (CNS) caused by the human polyoma virus JC (JCV). Human Immunodeficiency Virus (HIV) infection predisposes to PML. Very sparse data is available regarding the effect of Highly Active Anti Retroviral Therapy (HAART) on clinical outcome of PML in Indian settings. This study was carried out to look into clinical profile, survival and neurological outcome of HIV infected PML patients in HAART era.
Methods:
We looked in our cohort of HIV-1-infected individuals retrospectively. Diagnosis of PML was done on basis of clinical and radiological abnormalities highly suggestive of the condition, with or without confirmation of JCV DNA in the cerebrospinal fluid (CSF) by polymerase chain reaction (PCR).
Results:
Out of 892 HIV infected patients, 31 met the criteria for the diagnosis of PML. The median CD4+ cell count was 73 cells/µL (Interquartile range (IQR), 43-160 cells/µL) at the presentation of PML. Median duration of PML symptoms were 30 days (IQR, 15-60 days) before diagnosis of PML could be made. The median survival was 538 days. In those patients who survived more than one year, the median survival time was 1095 days (95% confidence interval (CI), 1090.35 -1099.64 days). Those who survived more than one year (n=13), Neurologic function were categorized as cure or improvement in 8, same status in 3 or progression in 2 patients.
Conclusions:
In the pre-HAART era, PML patients had very poor prognosis with median survival of 4-6 months after diagnosis. Till date HAART is the only way for reversal of immune system in HIV infected patients and its prompt institution is the most effective therapeutic approach in increasing survival in this group. In this study, 46.4% patients survived after 1 year on HAART. Amongst them, 69% patients completed 3 years. There is strong need of research for the development of pharmacotherapy against JC virus to increase the survival.
Insights
Highly Active Antiretroviral Therapy (HAART) significantly improves survival for Human Immunodeficiency Virus (HIV) patients with Progressive Multifocal Leukoencephalopathy (PML). Prompt HAART initiation enhances immune recovery and neurological outcomes in this vulnerable population.
Area of Science:
- Neurovirology
- Immunology
- Infectious Diseases
Background:
- Progressive Multifocal Leukoencephalopathy (PML) is a fatal CNS demyelinating disease caused by JC virus (JCV).
- Human Immunodeficiency Virus (HIV) infection is a major risk factor for PML.
- Limited data exists on PML outcomes in Indian HIV patients on Highly Active Antiretroviral Therapy (HAART).
Purpose of the Study:
- To investigate the clinical profile, survival, and neurological outcomes of HIV-infected PML patients in the HAART era in India.
- To assess the impact of HAART on PML prognosis within the Indian healthcare context.
Main Methods:
- Retrospective analysis of a cohort of HIV-1 infected individuals.
- PML diagnosis based on clinical and radiological findings, with optional JCV DNA confirmation in cerebrospinal fluid (CSF) via PCR.
Main Results:
- 31 out of 892 HIV patients were diagnosed with PML.
- Median CD4+ cell count at PML presentation was 73 cells/µL.
- Median survival was 538 days; 46.4% of patients survived beyond 1 year on HAART, with 69% of those surviving 3 years.
Conclusions:
- HAART is crucial for immune reconstitution and improving survival in HIV-associated PML.
- Prompt HAART initiation is the most effective strategy for increasing survival rates.
- Further research into JC virus-specific pharmacotherapy is needed to enhance long-term survival.
