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Progressive multifocal leukencephalopathy in patients on highly active antiretroviral therapy: survival and risk factors of death.
- Source :
-
Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2004 Oct 01; Vol. 37 (2), pp. 1263-8. - Publication Year :
- 2004
-
Abstract
- Objective: To describe the clinical course and risk factors of death in highly active antiretroviral therapy (HAART)-treated patients with progressive multifocal leukencephalopathy (PML); to evaluate the efficacy of cidofovir in addition to HAART.<br />Methods: Retrospective multicenter cohort study of PML in HIV-1-infected patients. Diagnosis of PML was confirmed by histology or by positive polymerase chain reaction for JC virus (JCV) in cerebrospinal fluid (CSF) or was made by typical radiologic and clinical findings.<br />Results: Thirty-five cases of PML were identified. The diagnosis was made by histology (9 cases), detection of JCV in CSF (17 cases), and by radiologic findings (9 cases). Upon manifestation of PML, 15/35 patients had never received HAART, and 11/35 were on HAART for >6 months (median 1126 days). In 9/35 cases, clinical manifestation of PML occurred within 6 months after initiation of HAART. All patients received HAART after PML diagnosis. After a median follow-up of 553 days (range 28-2694 days), the median survival time was not reached. In 12 patients who were treated concomitantly with cidofovir, cumulative survival was significantly shorter than in patients without cidofovir (P = 0.03). Patients in whom PML was diagnosed while on HAART demonstrated a trend toward a shorter survival than HAART-naive patients (P = 0.15).<br />Conclusions: PML continues to occur in HIV-1-infected patients even when they are treated with HAART. Patients developing PML on HAART had a trend toward a shorter median survival compared with treatment-naive patients, and cidofovir therapy was not associated with improved survival in this cohort.
- Subjects :
- Acquired Immunodeficiency Syndrome complications
Acquired Immunodeficiency Syndrome drug therapy
Acquired Immunodeficiency Syndrome virology
Adult
Anti-HIV Agents adverse effects
Anti-HIV Agents therapeutic use
CD4 Lymphocyte Count
Cidofovir
Cohort Studies
Cytosine therapeutic use
Female
Humans
JC Virus isolation & purification
Leukoencephalopathy, Progressive Multifocal etiology
Leukoencephalopathy, Progressive Multifocal mortality
Male
Middle Aged
Retrospective Studies
Risk Factors
Survival Analysis
Treatment Outcome
Acquired Immunodeficiency Syndrome immunology
Antiretroviral Therapy, Highly Active adverse effects
Cytosine analogs & derivatives
Leukoencephalopathy, Progressive Multifocal drug therapy
Organophosphonates therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1525-4135
- Volume :
- 37
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of acquired immune deficiency syndromes (1999)
- Publication Type :
- Academic Journal
- Accession number :
- 15385733
- Full Text :
- https://doi.org/10.1097/01.qai.0000136093.47316.f3