Department of Infectious Diseases, Ramón y Cajal Hospital, 28034, Madrid, Spain,
Eur J Clin Microbiol Infect Dis. 2014 Feb;33(2):179-87. doi: 10.1007/s10096-013-1941-6. Epub 2013 Aug 16.
To evaluate the situation and perspectives of progressive multifocal leukoencephalopathy (PML) in human immunodeficiency virus (HIV)-infected patients, we investigated changes in the incidence, causes, and long-term outcome of this disease in 72 acquired immunodeficiency syndrome (AIDS) patients who were diagnosed with PML from 1996 to 2011. Patients were classified according to the date of diagnosis in the first (1996-2000, n = 35), second (2001-2006, n = 26), and recent or third highly active antiretroviral therapy (HAART) period (2007-2011, n = 11). Overall, the incidence of PML decreased from 14.8 cases/1,000 patients/year in 1996 to 2.6 in 2005 and 0.8 in 2011, and nearly two-thirds of recent cases (64 %) were observed in HIV patients not attending clinical visits. The baseline median CD4+ count was higher in recently PML-diagnosed patients (77 vs. 86 vs. 101 cells/mm(3); p < 0.01), and this fact was associated with a cerebrospinal fluid (CSF) inflammatory profile (from 11 to 31 to 55 %, p = 0.007) and with a significantly longer survival (attributable death, 54 vs. 35 vs. 36 %, respectively, p < 0.01). Thus, the overall 1-year and 3-year survival rates were 55 and 50 %, respectively, increasing to 79 % at 1 year for patients with CD4+ count above 100 cells/mm(3) at diagnosis. In a Cox regression analysis, an older age (hazard ratio, HR 0.76), a baseline CD4+ count above 100 cells/mm(3) (HR 0.33), and a CSF inflammatory profile (HR 0.12) were significantly associated with a longer survival. The clinical presentation and outcome of PML in AIDS patients continue to change dramatically. Now, a declining incidence and long-term survival is observed.
为了评估人类免疫缺陷病毒（HIV）感染患者进行性多灶性白质脑病（PML）的现状和观点，我们调查了 72 例 1996 年至 2011 年间诊断为 PML 的获得性免疫缺陷综合征（AIDS）患者中这种疾病的发病率、病因和长期预后的变化。根据诊断日期，患者被分为三个时期：第一时期（1996-2000 年，n=35），第二时期（2001-2006 年，n=26）和最近或第三高效抗逆转录病毒治疗（HAART）时期（2007-2011 年，n=11）。总体而言，PML 的发病率从 1996 年的 14.8 例/1000 名患者/年降至 2005 年的 2.6 例和 2011 年的 0.8 例，最近近三分之二的病例（64%）发生在未就诊的 HIV 患者中。最近诊断为 PML 的患者的基线中位 CD4+计数较高（77 对 86 对 101 个细胞/mm3；p<0.01），并且这一事实与脑脊液（CSF）炎症特征（从 11%到 31%到 55%，p=0.007）相关，与显著延长的生存时间（归因死亡，分别为 54%对 35%对 36%，p<0.01）相关。因此，总的 1 年和 3 年生存率分别为 55%和 50%，对于诊断时 CD4+计数高于 100 个细胞/mm3的患者，1 年生存率增加到 79%。在 Cox 回归分析中，年龄较大（风险比，HR 0.76）、基线 CD4+计数高于 100 个细胞/mm3（HR 0.33）和 CSF 炎症特征（HR 0.12）与生存时间延长显著相关。艾滋病患者 PML 的临床表现和结局继续发生巨大变化。现在，发病率和长期生存率都在下降。
