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Sensitivity, Specificity, and Predicted Value

Sensitivity, Specificity, and Predicted Value

In healthcare diagnostics, laboratory tests play a crucial role in identifying and diagnosing a wide range of medical conditions. However, interpreting test results is not always straightforward. An abnormal test result does not always confirm the presence of a disease, just as a normal result does not guarantee its absence. To assess the reliability of these diagnostic tools, healthcare practitioners rely on two key statistical indicators: sensitivity and specificity.
Sensitivity is the...

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The boundaries between PML and PML-IRIS: difficult to define, pathology may predict.

Jiamin Chen¹, Yanni Du², Lei Sun¹

¹Department of Pathology, Beijing Ditan Hospital, Capital Medical University, Beijing, China.

Frontiers in Cellular and Infection Microbiology

|July 14, 2025

Summary

Progressive multifocal leukoencephalopathy (PML) in AIDS patients shows a more severe inflammatory response than previously reported, especially after antiretroviral therapy (ART). This suggests PML and PML-immune reconstitution inflammatory syndrome (IRIS) may be part of a continuous spectrum.

Keywords:

aids immune reconstitution inflammatory syndrome pathology progressive multifocal leukoencephalopathy radiology

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Area of Science:

Neurology
Immunology
Infectious Diseases

Background:

Progressive multifocal leukoencephalopathy (PML) is a critical neurological complication in individuals with AIDS-related immunosuppression.
JC virus reactivation is the causative agent of PML.
This study analyzed 19 confirmed PML cases in an AIDS cohort.

Purpose of the Study:

To conduct a clinicopathological analysis of PML cases in an AIDS cohort.
To investigate the characteristics of PML that deviate from classic presentations.
To explore the relationship between PML, immune reconstitution, and potential therapeutic strategies.

Main Methods:

Clinicopathological analysis of 19 AIDS-related PML cases.
Neuropathological evaluation including immunohistochemistry (SV40, NF, NeuN, P53, Ki-67, GFAP, Oligo-2, CD68) and myelin staining (Luxol fast blue).
Molecular diagnostics: quantitative JC viral load PCR and metagenomic next-generation sequencing (mNGS).

Main Results:

Significant correlations were found between mass effect and CD4+ T-cell counts and CSF protein levels.
HIV diagnosis duration correlated positively with inflammatory infiltration and plasma cell infiltration.
PML cases exhibited increased MRI enhancement and a more severe inflammatory response, particularly in patients on ART.

Conclusions:

PML and PML-immune reconstitution inflammatory syndrome (IRIS) may represent a continuous pathological spectrum with an intermediate stage.
This transitional phase highlights synergistic mechanisms of viral oncogenesis and immune reconstitution.
Findings could redefine therapeutic strategies for this emerging PML variant.