HIGHLY-ACTIVE ANTIRETROVIRAL THERAPY SIGNIFICANTLY IMPROVES THE PROGNOSIS OF PATIENTS WITH HIV-ASSOCIATED PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY

Objective: To evaluate the impact of different antiretroviral therapie s on the prognosis of AIDS patients affected by progressive multifocal leukoencephalopathy (PML). Methods: A retrospective analysis of all H IV-infected patients admitted to hospital between 1988 and 1996 found 29 patients (25 men) with histologically or PCR-confirmed PML. Their m ean age was 39.3 years. The median CD4 cell count was 40 x 10(6)/l (me an, 106 x 10(6)/l). Six patients had CD4 cell counts > 200 x 10(6)/l. Fourteen patients never received or stopped antiretroviral therapy fol lowing diagnosis (group A), 10 patients were treated with nucleoside a nalogues alone (group B), and five patients started highly active anti retroviral therapy (HAART) including protease inhibitors (group C). Re sults: The median survival following the onset of symptoms was 131 day s, but differed significantly between the three groups: group A, 127 d ays; group B, 123 days; group C, > 500 days (P < 0.0002 for the differ ence between group C versus group A and B, stratified log-rank test). As of July 1997, four out of five patients on HAART were still alive 3 91, 500, 543, and 589 days after diagnosis of PML and have either expe rienced a resolution of the symptoms (three patients) or had progresse d very slowly (one patient). A multivariate analysis using Cox regress ion found younger age at diagnosis to be the only other variable assoc iated with improved survival (P < 0.02). CD4 cell count, gender, prior AIDS diagnosis, mode of HIV transmission, and therapy with foscarnet, cytarabine, or interferon-a did not affect survival in this cohort (P > 0.1). Conclusion: This study of a large cohort of patients with con firmed PML indicates that AIDS patients with PML may benefit significa ntly from HAART. All patients with PML should be offered optimal antir etroviral combination therapy. (C) 1998 Lippincott-Raven Publishers.