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Diagnostic and Prognostic Value of JC Virus DNA in Plasma in Progressive Multifocal Leukoencephalopathy
- Source :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 67(1)
- Publication Year :
- 2017
-
Abstract
- Background Progressive multifocal leukoencephalopathy (PML) is a severe demyelinating disease caused by the polyomavirus JC (John Cunningham; JCV) that affects patients with impaired immune systems. While JCV-DNA detection in cerebrospinal fluid (CSF) is diagnostic of PML, the clinical significance of plasma JCV-DNA is uncertain. Methods We retrospectively analyzed plasma samples from PML patients that were drawn close to disease onset and from controls without PML. In PML patients, we compared plasma JCV-DNA detection and levels to clinical and laboratory parameters, and patient survival. Results JCV-DNA was detected in plasma of 49/103 (48%) patients with PML (20/24, 83%, human immunodeficiency virus [HIV] negative; 29/79, 37%, HIV-positive) and of 4/144 (3%) controls without PML (0/95 HIV-negative; 4/49, 8%, HIV-positive), yielding a diagnostic sensitivity and specificity of 48% and 97% (83% and 100% in HIV-negative; 37% and 92% in HIV-positive), respectively. Among 16 PML patients with undetectable CSF JCV-DNA, 4 (25%) had detectable plasma JCV-DNA. Plasma JCV-DNA levels were independently associated with CSF levels (P < .0001) and previous corticosteroid treatment (P = .012). Higher plasma JCV-DNA levels were associated with disease progression in HIV-negative patients (P = .005); in HIV-positive patients, there was an increased risk of progression only in those treated with combination antiretroviral therapy (cART; P < .0001). Conclusions Testing JCV-DNA in plasma might complement PML diagnosis, especially when CSF is unavailable or JCV-DNA not detectable in CSF. In addition, JCV-DNA plasma levels could be useful as a marker of disease progression in both HIV-negative and cART-treated, HIV-positive PML patients.
- Subjects :
- 0301 basic medicine
Microbiology (medical)
Adult
Male
medicine.medical_specialty
viruses
JC virus
HIV Infections
medicine.disease_cause
Gastroenterology
Polymerase Chain Reaction
Leukoencephalopathy
03 medical and health sciences
0302 clinical medicine
Natalizumab
Cerebrospinal fluid
Internal medicine
Demyelinating disease
medicine
Humans
Clinical significance
Survival analysis
Aged
Retrospective Studies
business.industry
Clinical Laboratory Techniques
Progressive multifocal leukoencephalopathy
Leukoencephalopathy, Progressive Multifocal
virus diseases
Middle Aged
medicine.disease
Prognosis
JC Virus
Survival Analysis
030104 developmental biology
Infectious Diseases
nervous system
Anti-Retroviral Agents
DNA, Viral
Disease Progression
Female
business
030217 neurology & neurosurgery
medicine.drug
Subjects
Details
- ISSN :
- 15376591
- Volume :
- 67
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Accession number :
- edsair.doi.dedup.....5f9e13cd2506591b9bd2ff1702463aed