Jm. Tassie et al., Survival improvement of AIDS-related progressive multifocal leukoencephalopathy in the era of protease inhibitors, AIDS, 13(14), 1999, pp. 1881-1887
Objective: To estimate the change in survival of patients with AIDS-related
progressive multifocal leukoencephalopathy (PML), in relation to the intro
duction of protease inhibitors (PI).
Design: The French Hospital Database on HIV (FHDH) is a prospective cohort
of 70 224 HIV-infected subjects. This study included the patients diagnosed
with PML between 1 July 1995 and 30 June 1997. PML diagnosis was both pres
umptive and confirmed. We compared the survival probability according to th
e diagnosis period (period 1 or 2, before or after introduction of PI in Fr
ance on 1 April 1996). Cox's model was used to calculate the relative hazar
ds of death according to the antiretroviral regimen.
Results: The study included 246 patients, 109 diagnosed during period 1 and
137 during period 2. In all, 131 patients received an antiretroviral combi
nation that included PI. By 31 December 1997, a total of 131 deaths had bee
n reported. The probability of survival at 6 months for patients from perio
d 2 was nearly twice as high as for patients from period 1 (60.5 versus 34.
5%). In comparison with patients receiving no treatment, the risk of death
in patients on combination therapy not including PI was reduced by 38% [rel
ative hazard (RH) 0.62, 95% confidence interval (Cl) (0.41; 0.95), P = 0.02
6] and in patients on combination therapy with PI, by 63% [RH 0.37, 95% Cl
(0.22; 0.64), P = 0.0004].
Conclusion: This study of a large cohort of patients diagnosed with PML (n
= 246), provides evidence that a combination antiretroviral regimen, especi
ally one including PI, confers marked survival benefits. (C) 1999 Lippincot
t Williams & Wilkins.