Progressive multifocal leukoencephalopathy associated with the human immunodeficiency virus infection: clinical, neuroimaging; virological and evolutive characteristics of 35 patients

BACKGROUND: The clinical, neuroimaging, virologic and evolutive characteris tics of progressive multifocal leukoencephalopathy (PML) in 35 AIDS patient s are studied. PATIENTS AND METHODS: PML was diagnosed by clinical and neuroimaging criter ia in 32 patients and by autopsy in other three. The detection of JC virus (JCV) was done by PCR and further hibridation of the amplified DNA in perip heral blood lymphocytes, urine and CSF. RESULTS: 127 of 930 HIV positive patients were admitted by neuropsychiatric symptoms and of them 35 (SD 27.6%) by PML. The PML patients had a mean CD4 lymphocytes count of 75.3 (82.0)/x 10(6)/l and a HIV viral load of 330,698 (538,971) copies of RNA/ml. Thirty patients did not receive any anti-retro viral therapy or only transcriptase inhibitors monotherapy and five triple anti-retroviral therapy, including a proteases inhibitor. Multiple hipodens e lesions on CT (53.1%) and T2 hyperintense lesions on MRI (58.3%) were the most frequent neuroimaging, findings. JCV was detected in 20/21 (95.2%) LM P patients: 18/19 detections in lymphocytes, 6/8 in CSF and 4/6 in urine. T he mean survival without and with antiretroviral therapy were 3.0 (0.47) an d 21.4 (4.4) months (p < 0.001) in 34 patients followed. PML progressed to death in 31/34 patients (91.2%), and remained stable in 3/34 (8.8%). A pati ent was lost for follow-up. CONCLUSIONS: The application of clinical and neuroimaging criteria and the detection of JCV in CSF are useful for high presumption diagnosis of PML wi thout brain biopsies. JCV detection in lymphocytes and in urine have a much lower predictive value, The evolution and survival of this disease can imp rove with triple anti-retroviral therapy including a protease inhibitor.