Progressive Multifocal Leukoencephalopathy: Improved Survival of Human Immunodeficiency Virus–infected Patients in the Protease Inhibitor Era

Dworkin, Mark S.; Wan, Pei; Hanson, Debra L.; Jones, Jeffrey L.

doi:10.1086/314937

Cited by 90 publications

(32 citation statements)

References 14 publications

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“…Prior evidence for a decreasing incidence of PML has been mixed. Similar declines in incidence were reported for HIV-positive patients in the USA [28,29] , and in the only national population-based study of PML incidence among HIV patients, conducted in Denmark, the incidence of PML among HIV-positive patients also decreased [30] . However, the prognosis remained poor for those patients who did contract the disease.…”

Section: Discussionsupporting

confidence: 73%

Progressive Multifocal Leukoencephalopathy Deaths in the USA, 1979–2005

et al. 2010

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Background: Progressive multifocal leukoencephalopathy (PML) is a neurological disease most often seen among immunosuppressed patients. The incidence of PML increased with an increasing incidence of HIV/AIDS. We describe recent trends and the epidemiology of PML-associated death in the era of highly active antiretroviral therapy (HAART). Methods: National multiple-cause-of-death data for the USA were used to identify records with PML listed as a cause of death during 1979–2005. Age-adjusted PML-associated death rates were calculated overall and by sex, race, region and HIV status. Results: The PML-associated death rates peaked in the mid-1990s and decreased from 2.76 deaths per 1 million persons in 1992–1995 to 0.66 in 2002–2005. This decrease was mainly due to a decreasing death rate among PML decedents with HIV diagnosis, males and those aged 20–49 years at death. A decline in death rate was also seen among PML decedents without HIV diagnosis, although this trend was not significant. Decedents in the latter time period were more often female, and older. The proportion of HIV-associated deaths from PML decreased between 1992–1995 (1.4%) and 2002–2005 (1.0%). Conclusion: PML mortality has decreased significantly since 1996 when HAART became the standard of care in the USA. This decline likely reflects increased survival among HIV-positive persons who receive HAART.

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Section: Discussionsupporting

confidence: 73%

Progressive Multifocal Leukoencephalopathy Deaths in the USA, 1979–2005

et al. 2010

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“…In addition, other factors, such as opportunistic infections [4][5][6][7][8][9], serum albumin concentrations [10,11], markers of immune activation [12,13], loss of body weight [10], and patient age [14,15], have been associated with clinical outcomes of HIV disease. These factors differ widely in the degree to which they accurately and independently predict disease progression or survival.…”

Section: Introductionmentioning

confidence: 99%

Associations of Anemia, Treatments for Anemia, and Survival in Patients with Human Immunodeficiency Virus Infection

Sullivan

2002

J INFECT DIS

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Three large observational cohort studies suggest that, after controlling for virus load and CD4 cell count, anemia is related to disease progression and survival in patients with human immunodeficiency virus (HIV) infection. Recovery from anemia has been linked to improved survival outcomes. Blood transfusion has been associated with accelerated disease progression and mortality in patients with HIV infection, and review of related literature suggests that the mechanism for negative transfusion-associated outcomes may be transfusion-related immunosuppression. Therefore, the use of transfusion should be restricted to patients with acute or severe anemia. Prescription of epoetin alfa has been associated with increased survival in an observational cohort among patients with HIV infection and anemia. In the absence of data from a clinical trial documenting the effect of treating anemia on survival, clinicians should consider non-transfusion options for management of anemia on the basis of clinical status and patient functional ability.

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“…The prognosis of PML has traditionally been poor, with a median duration of survival of 1-6 months after diagnosis. 5,[36][37][38] In recent years, many studies have documented improved survival rates among PML patients who receive HAART. 31,[37][38][39][40][41][42][43] This association may be strongest when therapy includes a protease inhibitor.…”

Section: Discussionmentioning

confidence: 99%

“…5,[36][37][38] In recent years, many studies have documented improved survival rates among PML patients who receive HAART. 31,[37][38][39][40][41][42][43] This association may be strongest when therapy includes a protease inhibitor. 44 There are some factors associated with prolonged survival in patients with PML: use of HAART, high CD4 cell count at time of diagnosis, increase of CD4 cell count by O100 cell/ml, low HIV viral load, PML as initial AIDS diagnosis, low JC virus levels in CSF, clearance of JC virus from CSF and lack of neurological progression 2 months after diagnosis.…”

Section: Discussionmentioning

confidence: 99%