Influence of HAART on the clinical course of HIV-1-infected patients with progressive multifocal leukoencephalopathy:: Results of an observational multicenter study

Background: The aim of this study was to analyze the incidence of new cases, survival of HIV-1-infected patients with progressive multifocal leukoencephalopathy (PML), and the characteristics of PML-associated immune reconstitution inflammatory syndrome (IRIS). Methods: Multicenter observational cohort Study of all HIV-1-infected patients newly diagnosed of PML in 7 hospitals in Barcelona (Spain) from 2002 to 2006. The annual incidence of PML was calculated. Survival was estimated using the Kaplan-Meier method. IRIS was defined as new onset or rapid worsening of PML shortly after initiation of highly active antiretroviral therapy together with a decline in HIV-1 viral load and rising of CD4 lymphocytes. Results: Sixty-one new cases of PML were diagnosed. The mean Survival time was 15 months [95% confidence interval (CI), I I to 19]. The Kaplan-Meier estimates of the probability of survival were 47.7% (95%) CI, 35 to 59) at 6 months, 38.6% (95% CI 25 to 5 1) at 12 months, 35.1% (95% CI, 22 to 48) at 24 months, and 25.1% (95% CI, 10 to 40) at 36 months. IRIS was diagnosed in 14 (23%) cases. Mortality was similar in patients with and without IRIS. Conclusions: PML continues to be one of the deadliest opportunistic infections in acquired immunodeficiency syndrome patients, The development of PML-associated IRIS has no influence on Prognosis.