Incidence, Clinical Presentation, and Outcome of Progressive Multifocal Leukoencephalopathy in HIV-Infected Patients during the Highly Active Antiretroviral Therapy Era: A Nationwide Cohort Study

Abstract

The incidence of PML in HIV-infected patients decreased after the introduction of HAART. Survival after PML remains poor. In the management of PML, the main focus should be on prophylactic measures to avoid immunodeficiency.

Progressive Multifocal Leukoencephalopathy Associated with Pulmonary Tuberculosis in an Immuno-Compromised Indian Patient

“…Bad prognostic indicators include a CD 4 count of less than 100/µL associated with other opportunistic infections [14]. There is no effective treatment for PML but with the advent of ART, the prognosis may be better [15][16][17]. Cidofovir and camptothecin are two new drugs which are being used in controlled clinical studies.…”

Progressive Multifocal Leukoencephalopathy in an HIV Patient

“…It is known that in HIV patients, PML often arises in severe immunocompromised states, when CD4 T cell count is lower than 200/mm 3 . Nevertheless, cases have been described with CD4 T cell count higher than that value [4,5,7,9]. Yet, case reports of definite PML with more than 500/mm 3 CD4 T cell count are quite rare.…”

“…HIV infection accounts for 85% of all cases of PML, with a prevalence estimated of 4-5% in this population [1,3]. The probability of an HIV patient developing neurological symptoms and PML lesions is higher amongst the ones with a lower immunological status, expressed by a CD4 T cell count lower than 200/mm 3 [4,5]. There are very few reports of PML among HIV infected patients with a better immunological condition, with more than 500 CD4/mm 3 [6].…”

A New Therapeutic Option for Progressive Multifocal Leukoencephalopathy after Allogeneic Hematopoietic Cell Transplantation

“…In HIV-positive patients with PML, the prognosis has been improving since the introduction of cART. Recent reports have shown that recovery of immune response induced by cART improve the prognosis in HIVpositive patients with PML [21,22].…”

“…The prevalence of PML increased substantially during HIV epidemic and mortality related to PML has also increased in the post-HIV era. However, the restoration of immune response by combination antiretroviral therapy (cART) has shown to induce the improvement of prognosis of PML [4]. Recently, immunomodulatory medications which suppress the host cellular immune response, such as nantalizumab for multiple sclerosis and rituximab for malignant lymphoma are associated with PML [5,6].…”