Continued declining incidence and improved survival of progressive multifocal leukoencephalopathy in HIV/AIDS patients in the current era
Continued declining incidence and improved survival of progressive multifocal leukoencephalopathy in HIV/AIDS patients in the current era
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DOI：
10.1007/s10096-013-1941-6
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发表时间：
2014-02-01
影响因子：
4.5
通讯作者：
Moreno, S.
中科院分区：
文献类型：
--
作者：
Casado, J. L.;Corral, I.;Moreno, S.
为了评估人类免疫缺陷病毒（HIV）感染患者中进行性多灶性白质脑病（PML）的情况和前景，我们调查了1996年至2011年期间72例诊断为PML的获得性免疫缺陷综合征（AIDS）患者中该病的发病率、病因和长期结局的变化。根据第一次（1996-2000，n = 35）、第二次（2001-2006，n = 26）和最近或第三次高效抗逆转录病毒治疗（HAART）阶段（2007-2011，n = 11）的诊断日期对患者进行分类。总体而言，PML的发病率从1996年的14.8例/1，000例患者/年降至2005年的2.6例和2011年的0.8例，近三分之二的近期病例（64%）在未参加临床访视的HIV患者中观察到。最近诊断为PML的患者的基线中位CD 4+计数较高（77 vs. 86 vs. 101 cells/mm（3）; p < 0.01），并且这一事实与脑脊液（CSF）炎症特征相关（从11到31到55%，p = 0.007）并且具有显著更长的存活率（归因死亡，分别为54对35对36%，p < 0.01）。因此，总的1年和3年生存率分别为55%和50%，对于诊断时CD 4+计数高于100个细胞/mm（3）的患者，1年生存率增加至79%。在考克斯回归分析中，年龄较大（风险比，HR 0.76）、基线CD 4+计数高于100个细胞/mm 3（HR 0.33）和CSF炎症特征（HR 0.12）与生存期延长显著相关。艾滋病患者PML的临床表现和结局继续发生显著变化。现在，观察到发病率和长期生存率下降。
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.