Epidemiology of progressive multifocal leukoencephalopathy in the United States

Abstract

We analyzed progressive multifocal leukoencephalopathy (PML) mortality data from 1979 to 1987 and data on persons with acquired immunodeficiency syndrome (AIDS) reported to the Centers for Disease Control (CDC). Based on analyses of multiple-cause-of-death vital statistics, deaths related to PML have increased fourfold from 1.5/10,000,000 persons in 1979 to 6.1/10,000,000 persons in 1987. The increase in the PML annual death rate began in 1984, occurred primarily in men 20 to 49 years of age, and was greatest in states known to have a high incidence of AIDS. In 1987, 56% of death certificates that listed PML as a cause of death also listed human immunodeficiency virus (HIV) infection. Analysis of AIDS case reports to the CDC from 1981 through June 1990 demonstrated that 0.72% of persons with AIDS were reported as having PML. Although most persons with AIDS who had PML were 20 to 49 years of age (84.6%), PML was reported more frequently among persons with AIDS greater than or equal to 50 years old than less than 50 years old. In addition, PML was reported more frequently among persons with AIDS who were exposed to HIV by blood transfusion than those in all other exposure categories. These data demonstrate that the increase in PML mortality from 1979 to 1987 was associated with the large increase in immunosuppressed persons with AIDS.

Progressive Multifocal Leukoencephalopathy in the United States, 1979–1994: Increased Mortality Associated with HIV Infection

“…Prior to 1984, lymphoproliferative diseases were the most common predisposing conditions for PML [4]. Since then, however, infection with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) have become the most important predisposing conditions [6]. By 1987, the year when specific diagnostic codes for HIV infection and AIDS were introduced in the 9th revision of the International Classification of Diseases (ICD-9), a 4-fold increase in PML mortality was reported, and HIV infection was listed on the death record of 56% of PML deaths [6].…”

Detection and Differentiation of Human Polyomaviruses JC and BK by LightCycler PCR

“…Polyomavirus-related disease is largely associated with immunological impairment, and rapid detection and differentiation of the etiological agent in immunocompromised patients are important to assist with clinical management. JCV is the causative agent of the neurological disease progressive multifocal leukoencephalopathy, which occurs primarily in AIDS patients (16,19), whereas BKV-associated disease includes hemorrhagic cystitis, ureteral stenosis, and other urinary tract disease, which are most commonly found in transplant patients undergoing immunosuppressive therapy (5,9).…”

Progressive Multifocal Leukoencephalopathy After Allogeneic Bone Marrow Transplantation for Acute Myeloid Leukemia

“…7 However, the increasing use of immunomodulating agents, such as monoclonal antibodies, in the treatment of oncologic and autoimmune diseases has led to the emergence and identification of new at-risk patient populations. Carson et al 8 reported 57 cases of PML in a large case series of patients treated with rituximab, although the true incidence of PML with rituximab therapy remains unclear.…”