Improved long-term survival among AIDS patients with progressive multifocal leukoencephalopathy receiving potent antiretroviral therapies
Abstract number: P787
Garcia-Garcia J., Casado J.L., Corral I., Moreno A., Dronda F., Perez-Elias M.J., Peris J., Moreno S.
Objective: To determine the outcome of progressive multifocal leukoencephalopathy (PML) in patients with AIDS.
Methods: A retrospective cohort of 52 subjects with AIDS who were diagnosed of PML (clinical and neuroradiological findings of active PML, no other aetiology, and/or PCR detection of JCV DNA in CSF, and/or histopathological findings in biopsy) from 1996 to 2007.
Results: At diagnosis, the median CD4+ cell count and plasma HIV RNA level were 93/mL (range, 7410/mL) and 4.8 log copies/mL (25.7), respectively. A probable immune reconstitution inflammatory syndrome (IRIS), defined as new onset (<180 days) of symptoms shortly after initiation of HAART, was described in 10 cases (19%). As expected, patients with IRIS had higher CD4+ count (181 vs 117/mL) and a lower HIV RNA level (2.95 vs 4.6 log copies/mL, p = 0.002) at the time of diagnosis. JCV DNA was detected in 52% of cases, and, of note, the CD4+ count was higher in patients presenting with a negative value (156 vs 113/mL). Moreover, JCV in CSF was mostly detected in patients without IRIS (57 vs 33%). During a median follow-up of 745 days, a total of 14 patients died (27%), most of them during the first 3 months after diagnosis (13 out of 14 cases, 93%). The probability of survival was 90% and 70% at 24 weeks for patients with or without IRIS, respectively (p = 0.15, log-rank test). There was no association between initial CD4+ count and mortality (28% vs 25% for patients below or above a CD4+ count of 100/mL). At the end of follow-up, HIV viral load was <50 copies/ml in 64% of cases, and CD4+ cell count was 357/mL, without differences according to initial response.
Conclusions: The prognosis of PML in patients with AIDS receiving potent antiretroviral therapies has improved significantly, and, for patients surviving three months after the diagnosis, the outcome is similar to that observed in the HIV population. IRIS diagnosis was not associated with a worse outcome.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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