Progressive multifocal leukoencephalopathy despite immune recovery in a HIV/HCV co-infected patient

In HIV patients, HCV co-infection has been associated with an increased risk of progressive multifocal leukoencephalopathy (PML). Furthermore, PML has also been described in patients with cirrhosis, whether related to HCV infection or not. We describe here the case of a HIV/HCV co-infected patient with cirrhosis who developed PML despite HIV suppression and CD4 cell count above 250/mm(3)for 2 years. Immunological studies performed at onset of PML and before HCV therapy showed a decrease in naive CD4 cells (CD45RA+CCR7(+)CD27(+)CD4(+)T cells - 23% cells, i.e. 75/mm(3)) and NK lymphopenia with abnormal and activated NK cells (CD3(-)CD16(+)and/or CD56(+)) (5% lymphocytes, i.e. 58/mm(3), CD69 91%, NKp30 26%). This impaired immunity, possibly related to HIV infection, or HCV infection or cirrhosis, or a combination thereof, could have led to the development of PML.