Human immunodeficiency virus (HIV)-associated progressive multifocal leukoencephalopathy (PML) remains a relevant clinical problem even in the era of highly active antiretroviral therapy (HAART). Aims of the study were to analyze clinical and treatment-related features and the survival probability of PML patients observed within the Italian Registry Investigative Neuro AIDS (IRINA) during a 29-month period of HAART. Intravenous drug use, the presence of focal signs, and the involvement of white matter at neuroradiology increased the risk of having PML. A reduced probability of PML was observed when meningeal signs were reported. Patients starting HAART at PML diagnosis and previously naive for antiretrovirals showed significantly higher 1-year probability of survival (.58), compared to those continuing HAART (.24), or never receiving HAART (.00). Higher CD4 cell count were associated with a higher survival probability (.45). At multivariate analysis, a younger age, higher CD4, starting HAART at PML diagnosis, the absence of previous acquired immunodeficiency syndrome (AIDS)-defining events, and the absence of a severe neurologic impairment were all associated with a reduced hazard of death. The use of cidofovir showed a trend towards a reduced risk of death.
Clinical epidemiology and survival of progressive multifocal leukoencephalopathy in the era of highly active antiretroviral therapy : data from the Italian Registry Investigative Neuro AIDS (IRINA) / A. Antinori, A. Cingolani, P. Lorenzini, M.L. Giancola, I. Uccella, S. Bossolasco, S. Grisetti, F. Moretti, B. Vigo, M. Bongiovanni, B. Del Grosso, M.I. Arcidiacono, G.C. Fibbia, M. Mena, M.G. Finazzi, G. Guaraldi, A. Ammassari, A. d'Arminio Monforte, P. Cinque, A. De Luca, F. Burzacchini, L. Mecocci, P. Giorni, L. Monno, G. Fasulo, O. Moling, S. Brighi, L. Sighinolfi, P. Corsi, M.T. Di Toro, A. Mastroianni, M. De Simone, G. Mazzarello, T. Carli, S. Artioli, A. Vetica, P. Congedo, P. Zannoni, S. Foresti, M. Figoni, E.R. Dallenogare, G. Rotondo, A. Agostinone, A. Mariano, A. Donisi, A. Vivarelli, L. Loiacono, B. Gigli, D. Larussa, M. Ciardi, F. Viviani, M. Palumbo, L. Cristiano, F. Speranza. - In: JOURNAL OF NEUROVIROLOGY. - ISSN 1355-0284. - 9:suppl. 1(2003), pp. 47-53.
Clinical epidemiology and survival of progressive multifocal leukoencephalopathy in the era of highly active antiretroviral therapy : data from the Italian Registry Investigative Neuro AIDS (IRINA)
A. d'Arminio Monforte;
2003
Abstract
Human immunodeficiency virus (HIV)-associated progressive multifocal leukoencephalopathy (PML) remains a relevant clinical problem even in the era of highly active antiretroviral therapy (HAART). Aims of the study were to analyze clinical and treatment-related features and the survival probability of PML patients observed within the Italian Registry Investigative Neuro AIDS (IRINA) during a 29-month period of HAART. Intravenous drug use, the presence of focal signs, and the involvement of white matter at neuroradiology increased the risk of having PML. A reduced probability of PML was observed when meningeal signs were reported. Patients starting HAART at PML diagnosis and previously naive for antiretrovirals showed significantly higher 1-year probability of survival (.58), compared to those continuing HAART (.24), or never receiving HAART (.00). Higher CD4 cell count were associated with a higher survival probability (.45). At multivariate analysis, a younger age, higher CD4, starting HAART at PML diagnosis, the absence of previous acquired immunodeficiency syndrome (AIDS)-defining events, and the absence of a severe neurologic impairment were all associated with a reduced hazard of death. The use of cidofovir showed a trend towards a reduced risk of death.
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