Incidence and outcome of progressive multifocal leukoencephalopathy over 20 years of the Swiss HIV Cohort Study.


Autoria(s): Khanna N.; Elzi L.; Mueller N.J.; Garzoni C.; Cavassini M.; Fux C.A.; Vernazza P.; Bernasconi E.; Battegay M.; Hirsch H.H.; Swiss HIV Cohort Study
Data(s)

2009

Resumo

BACKGROUND: We investigated the incidence and outcome of progressive multifocal leukoencephalopathy (PML) in human immunodeficiency virus (HIV)-infected individuals before and after the introduction of combination antiretroviral therapy (cART) in 1996. METHODS: From 1988 through 2007, 226 cases of PML were reported to the Swiss HIV Cohort Study. By chart review, we confirmed 186 cases and recorded all-cause and PML-attributable mortality. For the survival analysis, 25 patients with postmortem diagnosis and 2 without CD4+ T cell counts were excluded, leaving a total of 159 patients (89 before 1996 and 70 during 1996-2007). RESULTS: The incidence rate of PML decreased from 0.24 cases per 100 patient-years (PY; 95% confidence interval [CI], 0.20-0.29 cases per 100 PY) before 1996 to 0.06 cases per 100 PY (95% CI, 0.04-0.10 cases per 100 PY) from 1996 onward. Patients who received a diagnosis before 1996 had a higher frequency of prior acquired immunodeficiency syndrome-defining conditions (P = .007) but similar CD4+ T cell counts (60 vs. 71 cells/microL; P = .25), compared with patients who received a diagnosis during 1996 or thereafter. The median time to PML-attributable death was 71 days (interquartile range, 44-140 days), compared with 90 days (interquartile range, 54-313 days) for all-cause mortality. The PML-attributable 1-year mortality rate decreased from 82.3 cases per 100 PY (95% CI, 58.8-115.1 cases per 100 PY) during the pre-cART era to 37.6 cases per 100 PY (95% CI, 23.4.-60.5 cases per 100 PY) during the cART era. In multivariate models, cART was the only factor associated with lower PML-attributable mortality (hazard ratio, 0.18; 95% CI, 0.07-0.50; P < .001), whereas all-cause mortality was associated with baseline CD4+ T cell count (hazard ratio per increase of 100 cells/microL, 0.52; 95% CI, 0.32-0.85; P = .010) and cART use (hazard ratio, 0.37; 95% CI, 0.19-0.75; P = .006). CONCLUSIONS: cART reduced the incidence and PML-attributable 1-year mortality, regardless of baseline CD4+ T cell count, whereas overall mortality was dependent on cART use and baseline CD4+ T cell count.

Identificador

http://serval.unil.ch/?id=serval:BIB_EF984F365D70

isbn:1537-6591 (Electronic)

pmid:19348592

doi:10.1086/598335

isiid:000265749300020

Idioma(s)

en

Fonte

Clinical Infectious Diseases, vol. 48, no. 10, pp. 1459-1466

Palavras-Chave #Adult; Anti-HIV Agents/therapeutic use; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Cohort Studies; Female; HIV Infections/complications; HIV Infections/immunology; Humans; Incidence; Leukoencephalopathy, Progressive Multifocal/epidemiology; Leukoencephalopathy, Progressive Multifocal/mortality; Male; Switzerland/epidemiology; Treatment Outcome
Tipo

info:eu-repo/semantics/article

article