Epidemiology and prognosis of AIDS-associated progressive multifocal leukoencephalopathy in the HAART era
Epidemiology and prognosis of AIDS-associated progressive multifocal leukoencephalopathy in the HAART era
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DOI：
10.1080/13550280152537184
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发表时间：
2001-08-01
影响因子：
3.2
通讯作者：
De Luca, A
中科院分区：
文献类型：
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作者：
Antinori, A;Ammassari, A;De Luca, A
虽然大多数艾滋病相关的神经系统疾病的发病率降低，因为HAART治疗的介绍，我们发现，进行性多灶性白质脑病（PML）的发病率没有显着差异，HAART治疗前和HAART期间（OR 0.78; 95%CI 0.41-1.50）。这些发现得到了意大利登记调查性神经艾滋病（IRINA）研究的初步结果的证实，该研究是一项于2000年1月开始的前瞻性多中心研究，显示PML是仅次于TE的第二大最常诊断的神经系统疾病。在我们的经验中，在HAART初治和HAART经验丰富的患者中发现了相似比例的病例。PML在HIV RNA > 500 copies/ml的情况下更常见。HAART暴露患者中发生的大多数病例在治疗的前6个月内发生。正如其他人所报道的，我们发现接受HAART治疗的PML受试者的生存期延长（HAART治疗组为245天，未接受HAART治疗组为66天;对数秩P = 0.001）。然而，尽管生存受益，艾滋病相关的PML仍然有一个严重的预后。事实上，在我们的研究中，PML的1年生存率是所有脑疾病中最低的（P = 0.0005）。我们的研究结果还证实，基线时CSF JCV DNA负荷是一个有用的预后指标，根据我们的经验，阈值为4.7 log（10）JCV拷贝/ml（对数秩P = 0.01）。随访4周时CSF JCV DNA载量和CSF中JCV-DNA的清除率与更好的神经学结局和更长的生存期相关。
Whereas most AIDS-related neurologic disorders have reduced incidence since HAART therapy was introduced, we find that the incidence of progressive multifocal leukoencephalopathy (PML) did not significantly differ between the pre-HAART and the HAART period (OR 0.78; 95% CI 0.41-1.50). These findings were confirmed by the preliminary results of the Italian Register Investigative Neuro AIDS (IRINA) Study, a prospective multicenter study started in January 2000, which showed that PML was the second most frequently diagnosed neurologic disorder after TE. A similar proportion of cases were found in HAART-naive and HAART-experienced patients in our experience. PML was more common in the presence of HIV RNA > 500 copies/ml. Most of the cases occurring in HAART-exposed patients developed within the first 6 months of therapy. As others have reported, we find a prolonged survival in PML subjects prescribed HAART (245 days in the group treated with HAART versus 66 days in the group not treated with HAART; P at log rank = 0.001). However despite the survival benefit, AIDS-associated PML still has a serious prognosis. In fact, PML had the lowest 1-year survival probability of any cerebral disorder in our study (P = 0.0005). Our findings also confirm that CSF JCV DNA burden at baseline is a useful prognostic indicator with a threshold of 4.7 log(10) JCV copies/ml (P at log rank = 0.01) in our experience. CSF JCV DNA load at 4 weeks of follow-up and clearance of JCV-DNA from CSF are associated with a better neurologic outcome and a longer survival.