Engsig Frederik Neess, Hansen Ann-Brit Eg, Omland Lars Haukali, Kronborg Gitte, Gerstoft Jan, Laursen Alex Lund, Pedersen Court, Mogensen Christian Backer, Nielsen Lars, Obel Niels
Department of Infectious Diseases at Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
J Infect Dis. 2009 Jan 1;199(1):77-83. doi: 10.1086/595299.
Human immunodeficiency virus (HIV) infection predisposes to progressive multifocal leukoencephalopathy (PML). Here, we describe the incidence, presentation, and prognosis of PML in HIV-1-infected patients during the period before highly active antiretroviral therapy (HAART) (1995-1996) and during the early HAART (1997-1999) and late HAART (2000-2006) periods.
Patients from a nationwide population-based cohort of adult HIV-1-infected individuals were included. We calculated incidence rates of PML and median survival times after diagnosis. We also described neurological symptoms at presentation and follow-up.
Among 4,649 patients, we identified 47 patients with PML. The incidence rates were 3.3, 1.8, and 1.3 cases per 1000 person-years at risk in 1995-1996, 1997-1999, and 2000-2006, respectively. The risk of PML was significantly associated with low CD4(+) cell count, and 47% of cases were diagnosed by means of brain biopsy or polymerase chain reaction analysis for JC virus. The predominant neurological symptoms at presentation were coordination disturbance, cognitive defects, and limb paresis. Thirty-five patients died; the median survival time was 0.4 years (95% confidence interval [CI], 0.0-0.7) in 1995-1996 and 1.8 years (95% CI, 0.6-3.0) in both 1997-1999 and 2000-2006. CD4(+) cell count >50 cells/microL at diagnosis of PML was significantly associated with reduced mortality.
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.
人类免疫缺陷病毒（HIV）感染易引发进行性多灶性白质脑病（PML）。在此，我们描述了在高效抗逆转录病毒治疗（HAART）之前（1995 - 1996年）、HAART早期（1997 - 1999年）和HAART晚期（2000 - 2006年）期间，HIV - 1感染患者中PML的发病率、临床表现及预后情况。
纳入来自全国基于人群的成年HIV - 1感染个体队列的患者。我们计算了PML的发病率及诊断后的中位生存时间。我们还描述了发病时及随访期间的神经症状。
在4649例患者中，我们识别出47例PML患者。1995 - 1996年、1997 - 1999年和2000 - 2006年每1000人年的发病风险分别为3.3例、1.8例和1.3例。PML的发病风险与CD4(+)细胞计数低显著相关，47%的病例通过脑活检或针对JC病毒的聚合酶链反应分析得以诊断。发病时主要的神经症状为共济失调、认知缺陷和肢体轻瘫。35例患者死亡；1995 - 1996年的中位生存时间为0.4年（95%置信区间[CI]，0.0 - 0.7），1997 - 1999年和2000 - 2006年均为1.8年（95%CI，0.6 - 3.0）。PML诊断时CD4(+)细胞计数>50个/微升与死亡率降低显著相关。
引入HAART后，HIV感染患者中PML的发病率有所下降。PML后的生存情况仍然较差。在PML的管理中，主要重点应放在预防免疫缺陷的措施上。
