Gillespie S M, Chang Y, Lemp G, Arthur R, Buchbinder S, Steimle A, Baumgartner J, Rando T, Neal D, Rutherford G
Division of Viral and Ricketssial Diseases, Centers for Disease Control, Atlanta, GA.
Ann Neurol. 1991 Oct;30(4):597-604. doi: 10.1002/ana.410300413.
Progressive multifocal leukoencephalopathy (PML), a rare neurological disease, has been sporadically reported in persons infected with human immunodeficiency virus (HIV), the causative agent of acquired immune deficiency syndrome (AIDS). From January 1981 through February 1989, in San Francisco, we identified 94 HIV-infected persons with PML, of whom 48 (51%) were pathologically confirmed (as required for AIDS case reporting). These 48 patients were significantly older when diagnosed with AIDS (20% older than 50 years) than patients with AIDS without PML. The remaining 46 (49%) patients, diagnosed clinically and by neuroimaging, did not differ significantly from definitive patients in demographic or survival characteristics after PML diagnosis. We detected antibodies to JC virus, the causative agent of PML, in 9 of 14 (64%) AIDS-related patients with PML, and in 9 of 14 (64%) matched control subjects, suggesting that determination of JC virus antibody status before AIDS diagnosis does not reliably indicate which patients will contract PML. Our study shows that the proportion of patients with AIDS who contracted PML remained stable between 1981 and 1988, but increased in the first 2 months of 1989. Our findings further indicate that PML in HIV-infected patients may be underestimated by as much as 50%.
进行性多灶性白质脑病（PML）是一种罕见的神经系统疾病，在感染人类免疫缺陷病毒（HIV，获得性免疫缺陷综合征即艾滋病的病原体）的人群中曾有散发病例报道。1981年1月至1989年2月期间，在旧金山，我们识别出94例感染HIV且患有PML的患者，其中48例（51%）经病理确诊（符合艾滋病病例报告要求）。这些确诊为艾滋病的48例患者在诊断时的年龄明显比未患PML的艾滋病患者大（50岁以上的患者多出20%）。其余46例（49%）患者经临床和神经影像学诊断，在人口统计学特征或PML诊断后的生存特征方面与确诊患者无显著差异。在14例与艾滋病相关的PML患者中有9例（64%）检测到针对PML病原体JC病毒的抗体，在14例匹配的对照受试者中有9例（64%）检测到该抗体，这表明在艾滋病诊断前检测JC病毒抗体状态并不能可靠地表明哪些患者会感染PML。我们的研究表明，1981年至1988年期间感染艾滋病并患有PML的患者比例保持稳定，但在1989年的前两个月有所增加。我们的研究结果还表明，HIV感染患者中的PML可能被低估多达50%。
