AEGiS-13IAC: Neurological and virologic predictors of survival in AIDS-associated progressive multifocal Leukoencephalopathy (PML): the role of HAART.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Neurological and virologic predictors of survival in AIDS-associated progressive multifocal Leukoencephalopathy (PML): the role of HAART.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrB358)

Giancola ML, Tartaglione T, Ammassari A, Settecasi C, Cingolani A, Larussa D, Murri R, De Luca A
M. L. Giancola, Catholic University, Rome, Clinica delle Malattie Infettive, L.go Gemelli, 8, Roma, Italy, Tel.: +39 06 301-549-45, Fax: +39 06 305-45-19, E-mail: iclimi@rm.unicatt.it

OBJECTIVE: to establish the predictive value of clinical, neuroradiological, virologic and immunologic variables on the survival of AIDS-related PML.

METHODS: Retrospective analysis of clinical data collected according to pre-established protocol (demographics, neurological examination, Karnofsky, CD4, antiretroviral therapy), blinded retrospective examination of brain MRI and JCV-DNA quantitation in cerebrospinal fluid (CSF) by nested PCR. An MRI score was calculated based on number of brain areas involved.

RESULTS: 40 patients with histological or MRI+virologic diagnosis of PML were examined. 82.5% were M, median age was 35y, 12% MSM, 75% IDU, 12% heterosexual; 33% had a previous diagnosis of AIDS, median CD4 was 38/mmc (IQR 10-80), median Karnofsky 50 (range 20-80), median JCV-DNA in CSF 3.6 log₁₀/ml (range 3.0-6.3), median MRI score 10 (range 1-23) with a median number of 2 (range 1-11) brain lesions. 17 pts were treated with HAART, 23 with ARA-C ± antiretroviral monotherapy. Overall median survival from diagnosis was 68 days (range 19-905). Variables significantly associated with a longer survival were: HAART treatment (log-rank P = 0.02), CD4 > 100/mmc (P = 0.058), Karnofsky > 50 (P = 0.002), neurological response 2 months after diagnosis (P = 0.0001) and an MRI score > 10 (P = 0.08). Multivariate analysis by Cox regression model indicated HAART therapy (P = 0.029), Karnofsky (P = 0.017), 2-month neurological response (P = 0.023) and MRI score (P = 0.048) as independently predictive of longer survival. JCV-DNA concentration in CSF was significantly higher in pts with CD4 > 100 (mean 4.02 log vs 3.18 log; P = 0.018) and was marginally associated with survival in HAART-treated patients only (log rank P = 0.08).

CONCLUSIONS: HAART, severity of MRI picture and performance status significantly influence the prognosis of AIDS-related PML.

Keywords: AEGIS, Leukoencephalopathy, Progressive Multifocal, Antiretroviral Therapy, Highly Active, Acquired Immunodeficiency Syndrome, Survival, Prognosis, Polymerase Chain Reaction, Brain, Retrospective Studies, Human, virology, Cerebrospinal Fluid, Mortality
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TuOrB358