Abstract

MONTES SANTIAGO, J. et al. Progressive Multifocal Leukoencephalopathy in AIDS patients: any change in the highly active antiretrovial therapies era?. An. Med. Interna (Madrid) [online]. 2002, vol.19, n.5, pp.20-23. ISSN 0212-7199.

Aims: Progressive multifocal leukoencephalopathy (PML) develops in up to 4-8% of all AIDS patients. Before highly active antiretroviral therapies (HAART) the median survival was only 4-6 months. In this study we analyzed epidemiological parameters in AIDS-related LMP patients in search for differences in the incidence and prognosis between before and after HAART era. Mehods : Retrospective review of clinical histories of patients diagnosed of AIDS and PML at Hospital Meixoeiro in Vigo, Spain, between 01/01/94-31/05/97 (Before-HAART period) and 01/06/97-30/04/00 (After-HAART period). PML was diagnosed by clinical and neuroimaging criteria, with biopsy in 2 cases and positive JC virus hibridation in CSF in another case.  Results: We identified 12 patients (global prevalence of 3.8%, without differences between periods): 11 males, 10 intravenous drugs users (IDU), mean age of 38 years (31-43). In 6, LMP was the first opportunistic infection. When PML was diagnosed, 6 patients had a HIV viral load (VL)250.000 copies of RNA/ml (range, 254.000-3.170.000), and overall a mean CD4 lymphocytes counts of 89 x 10 ⁶/ml (40-134). Three patients received cytarabine+Interferon with zidovudine (2 patients) and zidovudine+lamivudine (1 patient) and other patient HAART+cidofovir, but no improvement was observed. The median survival was 10 months in before-HAART group and 17 months in after-HAART group, with a survival 48 months in 2 patients in the last group. Conclusions: LMP is observed in severely immunosuppressed IDU men (VLlog 5 copies RNA/ml and CD4<150 x106/ml). Complementary treatments were ineffective and only in patients with HAART a prolonged survival was observed.

Keywords : Progressive multifocal leukoencephalopathy; AIDS; JC virus.

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