Progressive multifocal leukoencephalopathy: Improved survival of human immunodeficiency virus-infected patients in the protease inhibitor era

To examine factors affecting survival after diagnosis of progressive multif ocal leukoencephalopathy (PML), we analyzed data from an observational coho rt study, the Adult and Adolescent Spectrum of HIV Disease project. We iden tified 415 patients diagnosed with PML during 1990-1997. The median surviva l time after diagnosis was 1 month. By use of an extended proportional haza rds, multivariate regression model, risk factors associated with decreased survival time included CD4 count <0.20 x 10(9) cells/L (risk ratio [RR], 2. 1; 95% confidence interval [CI], 1.3-3.5) compared with <0.20 x 10(9) cells /L, whereas factors associated with increased survival time were prescripti on of antiretroviral medication that contained a protease inhibitor (RR, 0. 2; 95% CI, 0.1-0.4) and prescription of other antiretroviral medication (RR , 0.6; 95% CI, 0.5-0.8) compared with no antiretroviral prescription. We co nclude that protease inhibitor use tin combination antiretroviral therapy) is likely to favorably affect survival time after diagnosis of PML.