Survival improvement of AIDS-related progressive multifocal leukoencephalopathy in the era of protease inhibitors

Tassie, Jean-Michel; Grill, Jacques; Bentata, M.; Deloumeaux, Jacqueline; Billaud, Éric; Costagliola, Dominique

doi:10.1097/00002030-199910010-00010

Cited by 85 publications

(39 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The highest rates of up to 8% were reported in HIV/AIDS in the pre-cART era and have significantly declined since the (1,4,31). Our nested case-control study of patients prospectively enrolled in the SHCS provides evidence that low T-cell immunity specifically directed at JCV is a key feature of the disease.…”

Section: Discussionmentioning

confidence: 71%

“…In HIV/AIDS, however, the availability of combination antiretroviral therapy (cART) has significantly improved the prognosis and largely reduced the incidence rates of PML (3,10). Nevertheless, mortality still approximates 50% within the first year (2,31). Recent data show that JCV-specific cytotoxic T lymphocytes in the peripheral blood at diagnosis may be associated with a better outcome, but independent studies of prospectively collected patients are missing (12,24).…”

mentioning

confidence: 99%

See 1 more Smart Citation

JC Virus-Specific Immune Responses in Human Immunodeficiency Virus Type 1 Patients with Progressive Multifocal Leukoencephalopathy

Khanna

Wolbers

Mueller

et al. 2009

J Virol

View full text Add to dashboard Cite

Progressive multifocal leukoencephalopathy (PML) is a frequently fatal disease caused by uncontrolled polyomavirus JC (JCV) in severely immunodeficient patients. We investigated the JCV-specific cellular and humoral immunity in the Swiss HIV Cohort Study. We identified PML cases (n ‫؍‬ 29), as well as three matched controls per case (n ‫؍‬ 87), with prospectively cryopreserved peripheral blood mononuclear cells and plasma at diagnosis. Nested controls were matched according to age, gender, CD4؉ T-cell count, and decline. Survivors (n ‫؍‬ 18) were defined as being alive for >1 year after diagnosis. Using gamma interferon enzyme-linked immunospot assays, we found that JCV-specific T-cell responses were lower in nonsurvivors than in their matched controls (P ‫؍‬ 0.08), which was highly significant for laboratory-and histologically confirmed PML cases (P ‫؍‬ 0.004). No difference was found between PML survivors and controls or for cytomegalovirus-specific T-cell responses. PML survivors showed significant increases in JCV-specific T cells (P ‫؍‬ 0.04) and immunoglobulin G (IgG) responses (P ‫؍‬ 0.005). IgG responses in survivors were positively correlated with CD4 ؉ T-cell counts (P ‫؍‬ 0.049) and negatively with human immunodeficiency virus RNA loads (P ‫؍‬ 0.03). We conclude that PML nonsurvivors had selectively impaired JCV-specific T-cell responses compared to CD4 ؉

show abstract

Section: Discussionmentioning

confidence: 71%

mentioning

confidence: 99%

JC Virus-Specific Immune Responses in Human Immunodeficiency Virus Type 1 Patients with Progressive Multifocal Leukoencephalopathy

Khanna

Wolbers

Mueller

et al. 2009

J Virol

View full text Add to dashboard Cite

show abstract

“…17 Briefly, FHDH-ANRS CO4 is an open cohort study conducted by a clinical epidemiologic network that was initiated in 1992 and that includes 70 French teaching hospitals belonging to 26 HIV treatment and information centers (COREVIH) located in both mainland France and French overseas territories. The cohort includes patients who have documented HIV-1 or HIV-2 infection and who have given their written informed consent to participate in the database in accordance with the Declaration of Helsinki.…”

Section: Patientsmentioning

confidence: 99%

HIV-associated Hodgkin lymphoma during the first months on combination antiretroviral therapy

Lanoy

Rosenberg

Fily

et al. 2011

Blood

Self Cite

View full text Add to dashboard Cite

Hodgkin lymphoma (HL) incidence with HIV infection may have increased with the introduction of combination antiretroviral therapy (cART), suggesting that immune reconstitution may contribute to some cases. We evaluated HL risk with cART during the first months of treatment. With 187 HL cases among 64 368 HIV patients in France, relative rates (RRs) and 95% confidence intervals (CIs) of HL were estimated using Poisson models for duration of cART, CD4 count, and HIV load, with and without adjustment for demographic/ clinical covariates. HL risk was unrelated to cART use overall, but it was related to time intervals after cART initiation (P ‫؍‬ .006). Risk was especially and significantly elevated in months 1-3 on cART (RR 2.95, CI 1.64-5.31), lower in months 4-6 (RR 1.63), and null with longer use (RR 1.00). CD4 count was strongly associated with HL risk (P < 10 ؊6 ), with the highest HL incidence at 50-99 CD4 cells/mm 3 . With adjustment for CD4 count and covariates, HL risk was elevated, but not significantly (RR 1.42), in months 1-3 on cART. HIV load had no added effect. HL risk increased significantly soon after cART initiation, which was largely explained by the CD4 count. IntroductionHodgkin lymphoma (HL) incidence is significantly elevated in the HIV-infected population. [1][2][3] In addition, since the advent of combination antiretroviral therapy (cART) in 1996, studies in the United States 4 and the United Kingdom 5 have reported an increase in the incidence of HL compared with the pre-cART era. For example, among people with AIDS in the United States, the incidence of HL was shown to be elevated 8-fold compared with the general population during the pre-cART era, and this increased significantly to 13-fold during the cART era. 1 Excess risk of HL in a second US population and among the HIV-infected population in France was shown to be very high during the pre-cART era. 2,6 In the French study, HL incidence increased even more (by 1.4-fold) during the cART era compared with the pre-cART era. 2 In the Swiss HIV Cohort Study, HL risk was 3-fold higher in the cART era compared with the pre-cART era in an analysis of the first 18 cases, 7 but this was not statistically significant and no increment in the cART era was found in an updated analysis of 47 HL cases. 8 Increased HL in the cART era has been postulated to be related to the actual use of cART, with a potential role for immunologic mechanisms. 2,4,9 Some support for an effect of cART on HL risk was provided by the British and initial Swiss studies, but these findings were marginally significant and were adjusted little or not at all for immune deficiency. 5,7 The British study also suggested that the excess risk of HL might specifically relate to the use of non-nucleoside reverse transcriptase inhibitors (NNRTIs). 5 Immune perturbation, and its control by cART, is likely to be integral to the development of HIV-associated HL. The relative risk (RR) of HIV-associated HL is 3.5-fold higher after AIDS onset, 10 and a lower CD4 lymphocyte count generally ...

show abstract

“…Cidofovir, um análogo de nucleotídeo, tem mostrado eficácia in vitro contra o vírus JC, e é droga promissora no tratamento da LMP 19 . Estudos sugerem que o uso de terapia anti-retroviral combinada (HAART) possa resultar em regressão da doença, com melhora da sobrevida [20][21][22][23][24][25][26] . Na maior série publicada (n=57) 23 , melhora neurológica foi vista após 2 meses de tratamento em apenas 4% dos pacientes sem uso de HAART, enquanto que 26% dos pacientes com uso de HAART mostraram melhora ou estabilidade neurológica (p=0,03); 8% e 57%, respectivamente, alcançaram níveis indetectáveis de DNA do vírus JC no líquor (p=0,04).…”

Section: Discussionunclassified

Leucoencefalopatia multifocal progressiva confirmada por PCR para vírus JC no líquor: relato de caso

Pasqualotto

Mattos

Rocha

2004

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

Relatamos um caso de leucoencefalopatia multifocal progressiva, doença infecciosa desmielinizante do sistema nervoso central, seguido de revisão da literatura. Comenta-se a importância diagnóstica dos métodos de imagem, bem como da análise do líquor e da técnica de reação em cadeia da polimerase (PCR). Até o presente momento, não há terapia efetiva para a condição, com sobrevida média de 1-6 meses nos pacientes não tratados; evolução favorável pode ocorrer no subgrupo de pacientes que obtém melhora da imunidade com o uso de terapia anti-retroviral.

show abstract

Survival improvement of AIDS-related progressive multifocal leukoencephalopathy in the era of protease inhibitors

Abstract: This study of a large cohort of patients diagnosed with PML (n = 246), provides evidence that a combination antiretroviral regimen, especially one including PI, confers marked survival benefits.

Cited by 85 publications

References 23 publications

JC Virus-Specific Immune Responses in Human Immunodeficiency Virus Type 1 Patients with Progressive Multifocal Leukoencephalopathy

JC Virus-Specific Immune Responses in Human Immunodeficiency Virus Type 1 Patients with Progressive Multifocal Leukoencephalopathy

HIV-associated Hodgkin lymphoma during the first months on combination antiretroviral therapy

Leucoencefalopatia multifocal progressiva confirmada por PCR para vírus JC no líquor: relato de caso

Contact Info

Product

Resources

About