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From Clinical Presentation to the Outcome: the Natural History of PML in a Portuguese Population of HIV Infected Patients

BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system, associated with immunosuppression states. As there are only some non-published documents concerning PML in HIV infected patients in Portugal, we pretend to characterize natural hist...

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Autores principales: Nery, Filipe, Franca, Margarida, Almeida, Isabel, Vasconcelos, Carlos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elmer Press 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194021/
https://www.ncbi.nlm.nih.gov/pubmed/22043267
http://dx.doi.org/10.4021/jocmr501w
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author Nery, Filipe
Franca, Margarida
Almeida, Isabel
Vasconcelos, Carlos
author_facet Nery, Filipe
Franca, Margarida
Almeida, Isabel
Vasconcelos, Carlos
author_sort Nery, Filipe
collection PubMed
description BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system, associated with immunosuppression states. As there are only some non-published documents concerning PML in HIV infected patients in Portugal, we pretend to characterize natural history of PML infection in a population of HIV patients. METHODS: We retrospectively reviewed, from 1992 to 2009, PML cases in a population of 724 HIV infected patients followed in our institution. Clinical, biological, imagery features and outcomes were characterized. RESULTS: Twenty-five (3.45%) patients were identified as having PML. The mean time between HIV and PML diagnosis was 20.4 months. PML was the presentation of HIV infection in 40% of the patients, and 92% had CD4 T cell count lower than 200/mm(3). Paresis was the most common clinical presentation. No specific characteristics were found in cerebrospinal fluid and JCV DNA was positive in 3 of 7 patients. MRI revealed characteristic findings. Combined antiretroviral therapy was started or changed in 96% of the patients. Neurological condition got worse in 12 patients. From the 14 deaths, 5 were directly attributed to PML progression. Follow-up was lost in 8 patients. CONCLUSIONS: PML was the presentation of HIV infection in more than 1/3 of patients, frequently associated with advanced immunocompromise. MRI sensitivity to PML is high, and JCV DNA determination in CSF was not revealed to be sensible. PML diagnosis should be taken into account in HIV patients presenting any neurological symptoms, and HIV infection should be suspected when radiological findings suggest PML lesions even in previously healthy individuals. KEYWORDS: Progressive multifocal leukoencephalopathy; JC virus; Human immunodeficiency virus; Demyelinating disease
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spelling pubmed-31940212011-10-31 From Clinical Presentation to the Outcome: the Natural History of PML in a Portuguese Population of HIV Infected Patients Nery, Filipe Franca, Margarida Almeida, Isabel Vasconcelos, Carlos J Clin Med Res Original Article BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system, associated with immunosuppression states. As there are only some non-published documents concerning PML in HIV infected patients in Portugal, we pretend to characterize natural history of PML infection in a population of HIV patients. METHODS: We retrospectively reviewed, from 1992 to 2009, PML cases in a population of 724 HIV infected patients followed in our institution. Clinical, biological, imagery features and outcomes were characterized. RESULTS: Twenty-five (3.45%) patients were identified as having PML. The mean time between HIV and PML diagnosis was 20.4 months. PML was the presentation of HIV infection in 40% of the patients, and 92% had CD4 T cell count lower than 200/mm(3). Paresis was the most common clinical presentation. No specific characteristics were found in cerebrospinal fluid and JCV DNA was positive in 3 of 7 patients. MRI revealed characteristic findings. Combined antiretroviral therapy was started or changed in 96% of the patients. Neurological condition got worse in 12 patients. From the 14 deaths, 5 were directly attributed to PML progression. Follow-up was lost in 8 patients. CONCLUSIONS: PML was the presentation of HIV infection in more than 1/3 of patients, frequently associated with advanced immunocompromise. MRI sensitivity to PML is high, and JCV DNA determination in CSF was not revealed to be sensible. PML diagnosis should be taken into account in HIV patients presenting any neurological symptoms, and HIV infection should be suspected when radiological findings suggest PML lesions even in previously healthy individuals. KEYWORDS: Progressive multifocal leukoencephalopathy; JC virus; Human immunodeficiency virus; Demyelinating disease Elmer Press 2011-02 2011-02-12 /pmc/articles/PMC3194021/ /pubmed/22043267 http://dx.doi.org/10.4021/jocmr501w Text en Copyright © 2011, Nery et al. http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Nery, Filipe
Franca, Margarida
Almeida, Isabel
Vasconcelos, Carlos
From Clinical Presentation to the Outcome: the Natural History of PML in a Portuguese Population of HIV Infected Patients
title From Clinical Presentation to the Outcome: the Natural History of PML in a Portuguese Population of HIV Infected Patients
title_full From Clinical Presentation to the Outcome: the Natural History of PML in a Portuguese Population of HIV Infected Patients
title_fullStr From Clinical Presentation to the Outcome: the Natural History of PML in a Portuguese Population of HIV Infected Patients
title_full_unstemmed From Clinical Presentation to the Outcome: the Natural History of PML in a Portuguese Population of HIV Infected Patients
title_short From Clinical Presentation to the Outcome: the Natural History of PML in a Portuguese Population of HIV Infected Patients
title_sort from clinical presentation to the outcome: the natural history of pml in a portuguese population of hiv infected patients
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194021/
https://www.ncbi.nlm.nih.gov/pubmed/22043267
http://dx.doi.org/10.4021/jocmr501w
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