Incidence, clinical presentation, and outcome of progressive multifocal leukoencephalopathy in HIV-infected patients during the highly active antiretroviral therapy era: a nationwide cohort study

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 th...

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Vydáno v:	The Journal of infectious diseases Ročník 199; číslo 1; s. 77
Hlavní autoři:	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
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 01.01.2009
Témata:	Antiretroviral Therapy, Highly Active CD4 Lymphocyte Count Cognition Disorders - epidemiology Cognition Disorders - etiology Cohort Studies Demography Denmark - epidemiology Female HIV Infections - complications HIV Infections - drug therapy Humans Incidence Leukoencephalopathy, Progressive Multifocal - epidemiology Leukoencephalopathy, Progressive Multifocal - mortality Leukoencephalopathy, Progressive Multifocal - prevention & control Male Risk Factors Seizures - epidemiology Seizures - etiology Speech Disorders - epidemiology Speech Disorders - etiology Survival Analysis Treatment Outcome Vision Disorders - epidemiology Vision Disorders - etiology Denmark
ISSN:	0022-1899
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Abstract	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.
AbstractList	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.BACKGROUNDHuman 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.METHODSPatients 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.RESULTSAmong 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.CONCLUSIONSThe 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. 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.
Author	Laursen, Alex Lund Kronborg, Gitte Pedersen, Court Nielsen, Lars Hansen, Ann-Brit Eg Mogensen, Christian Backer Gerstoft, Jan Obel, Niels Engsig, Frederik Neess Omland, Lars Haukali
Author_xml	– sequence: 1 givenname: Frederik Neess surname: Engsig fullname: Engsig, Frederik Neess email: fren74@gmail.com organization: Department of Infectious Diseases at Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. fren74@gmail.com – sequence: 2 givenname: Ann-Brit Eg surname: Hansen fullname: Hansen, Ann-Brit Eg – sequence: 3 givenname: Lars Haukali surname: Omland fullname: Omland, Lars Haukali – sequence: 4 givenname: Gitte surname: Kronborg fullname: Kronborg, Gitte – sequence: 5 givenname: Jan surname: Gerstoft fullname: Gerstoft, Jan – sequence: 6 givenname: Alex Lund surname: Laursen fullname: Laursen, Alex Lund – sequence: 7 givenname: Court surname: Pedersen fullname: Pedersen, Court – sequence: 8 givenname: Christian Backer surname: Mogensen fullname: Mogensen, Christian Backer – sequence: 9 givenname: Lars surname: Nielsen fullname: Nielsen, Lars – sequence: 10 givenname: Niels surname: Obel fullname: Obel, Niels
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/19007313$$D View this record in MEDLINE/PubMed
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References	19358677 - J Infect Dis. 2009 May 1;199(9):1410-1; author reply 1411-2
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SubjectTerms	Antiretroviral Therapy, Highly Active CD4 Lymphocyte Count Cognition Disorders - epidemiology Cognition Disorders - etiology Cohort Studies Demography Denmark - epidemiology Female HIV Infections - complications HIV Infections - drug therapy Humans Incidence Leukoencephalopathy, Progressive Multifocal - epidemiology Leukoencephalopathy, Progressive Multifocal - mortality Leukoencephalopathy, Progressive Multifocal - prevention & control Male Risk Factors Seizures - epidemiology Seizures - etiology Speech Disorders - epidemiology Speech Disorders - etiology Survival Analysis Treatment Outcome Vision Disorders - epidemiology Vision Disorders - etiology
Title	Incidence, clinical presentation, and outcome of progressive multifocal leukoencephalopathy in HIV-infected patients during the highly active antiretroviral therapy era: a nationwide cohort study
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