Progressive multifocal leukoencephalopathy in HIV-infected patients in the era of HAART

Radiological features at diagnosis and follow-up and correlation with clinical variables

Maria Letizia Giancola, Elisa Busi Rizzi, Patrizia Lorenzini, Laura Rovighi, Francesco Baldini, Vincenzo Schininà, Dora Larussa, Corrado Bibbolino, Andrea Antinori

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Abstract

The magnetic resonance (MR) imaging patterns of HIV-infected patients affected by progressive multifocal leukoencephalopathy (PML) in the HAART era have not been extensively documented. The aim of the present study is to describe the MR features of PML in HIV-infected patients at diagnosis, and the evolution during follow-up, evaluating the impact of HAART on imaging, and to correlate the MR pattern with the virological and immunological levels and with survival. We retrospectively reviewed MR imaging at baseline and at the last available follow-up within 6 months of diagnosis (median 4 months, range 1-6) of 31 HIV-positive patients affected by PML. A closer follow-up [median interval from diagnosis 39 days (range 20-139)] was also reported. At the onset of neurological disorder, 19 patients were naive for antiretroviral therapy, 7 patients were on HAART, and 5 patients were experienced but were not taking antiretroviral therapy. Upon PML diagnosis no significant differences at imaging were observed between naive and experienced patients and HAART-treated or non-HAART-treated patients. MR findings were not related to immunological status, either at baseline or at follow-up. A radiological improvement within 6 months was associated with a higher probability of a more favorable clinical evolution [OR 14.0 (2.2-87.2), p = 0.003]. The overall probability of survival at 6 months was 61.5%. A better survival was observed in patients with stable or improved MR imaging findings within 6 months [HR 4.55 (95%CI 1.36-15.19, p = 0.009]. Although HAART prolonged the survival of HIV-positive patients affected by PML, it did not seem to influence the PML MR pattern of presentation and the imaging evolution. Only the radiological outcome was predictive of clinical outcome.

Original languageEnglish
Pages (from-to)155-162
Number of pages8
JournalAIDS Research and Human Retroviruses
Volume24
Issue number2
DOIs
Publication statusPublished - Feb 1 2008

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Progressive Multifocal Leukoencephalopathy
Highly Active Antiretroviral Therapy
HIV
Magnetic Resonance Spectroscopy
Survival
Magnetic Resonance Imaging
Nervous System Diseases

ASJC Scopus subject areas

  • Immunology
  • Virology

Cite this

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title = "Progressive multifocal leukoencephalopathy in HIV-infected patients in the era of HAART: Radiological features at diagnosis and follow-up and correlation with clinical variables",
abstract = "The magnetic resonance (MR) imaging patterns of HIV-infected patients affected by progressive multifocal leukoencephalopathy (PML) in the HAART era have not been extensively documented. The aim of the present study is to describe the MR features of PML in HIV-infected patients at diagnosis, and the evolution during follow-up, evaluating the impact of HAART on imaging, and to correlate the MR pattern with the virological and immunological levels and with survival. We retrospectively reviewed MR imaging at baseline and at the last available follow-up within 6 months of diagnosis (median 4 months, range 1-6) of 31 HIV-positive patients affected by PML. A closer follow-up [median interval from diagnosis 39 days (range 20-139)] was also reported. At the onset of neurological disorder, 19 patients were naive for antiretroviral therapy, 7 patients were on HAART, and 5 patients were experienced but were not taking antiretroviral therapy. Upon PML diagnosis no significant differences at imaging were observed between naive and experienced patients and HAART-treated or non-HAART-treated patients. MR findings were not related to immunological status, either at baseline or at follow-up. A radiological improvement within 6 months was associated with a higher probability of a more favorable clinical evolution [OR 14.0 (2.2-87.2), p = 0.003]. The overall probability of survival at 6 months was 61.5{\%}. A better survival was observed in patients with stable or improved MR imaging findings within 6 months [HR 4.55 (95{\%}CI 1.36-15.19, p = 0.009]. Although HAART prolonged the survival of HIV-positive patients affected by PML, it did not seem to influence the PML MR pattern of presentation and the imaging evolution. Only the radiological outcome was predictive of clinical outcome.",
author = "Giancola, {Maria Letizia} and Rizzi, {Elisa Busi} and Patrizia Lorenzini and Laura Rovighi and Francesco Baldini and Vincenzo Schinin{\`a} and Dora Larussa and Corrado Bibbolino and Andrea Antinori",
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T1 - Progressive multifocal leukoencephalopathy in HIV-infected patients in the era of HAART

T2 - Radiological features at diagnosis and follow-up and correlation with clinical variables

AU - Giancola, Maria Letizia

AU - Rizzi, Elisa Busi

AU - Lorenzini, Patrizia

AU - Rovighi, Laura

AU - Baldini, Francesco

AU - Schininà, Vincenzo

AU - Larussa, Dora

AU - Bibbolino, Corrado

AU - Antinori, Andrea

PY - 2008/2/1

Y1 - 2008/2/1

N2 - The magnetic resonance (MR) imaging patterns of HIV-infected patients affected by progressive multifocal leukoencephalopathy (PML) in the HAART era have not been extensively documented. The aim of the present study is to describe the MR features of PML in HIV-infected patients at diagnosis, and the evolution during follow-up, evaluating the impact of HAART on imaging, and to correlate the MR pattern with the virological and immunological levels and with survival. We retrospectively reviewed MR imaging at baseline and at the last available follow-up within 6 months of diagnosis (median 4 months, range 1-6) of 31 HIV-positive patients affected by PML. A closer follow-up [median interval from diagnosis 39 days (range 20-139)] was also reported. At the onset of neurological disorder, 19 patients were naive for antiretroviral therapy, 7 patients were on HAART, and 5 patients were experienced but were not taking antiretroviral therapy. Upon PML diagnosis no significant differences at imaging were observed between naive and experienced patients and HAART-treated or non-HAART-treated patients. MR findings were not related to immunological status, either at baseline or at follow-up. A radiological improvement within 6 months was associated with a higher probability of a more favorable clinical evolution [OR 14.0 (2.2-87.2), p = 0.003]. The overall probability of survival at 6 months was 61.5%. A better survival was observed in patients with stable or improved MR imaging findings within 6 months [HR 4.55 (95%CI 1.36-15.19, p = 0.009]. Although HAART prolonged the survival of HIV-positive patients affected by PML, it did not seem to influence the PML MR pattern of presentation and the imaging evolution. Only the radiological outcome was predictive of clinical outcome.

AB - The magnetic resonance (MR) imaging patterns of HIV-infected patients affected by progressive multifocal leukoencephalopathy (PML) in the HAART era have not been extensively documented. The aim of the present study is to describe the MR features of PML in HIV-infected patients at diagnosis, and the evolution during follow-up, evaluating the impact of HAART on imaging, and to correlate the MR pattern with the virological and immunological levels and with survival. We retrospectively reviewed MR imaging at baseline and at the last available follow-up within 6 months of diagnosis (median 4 months, range 1-6) of 31 HIV-positive patients affected by PML. A closer follow-up [median interval from diagnosis 39 days (range 20-139)] was also reported. At the onset of neurological disorder, 19 patients were naive for antiretroviral therapy, 7 patients were on HAART, and 5 patients were experienced but were not taking antiretroviral therapy. Upon PML diagnosis no significant differences at imaging were observed between naive and experienced patients and HAART-treated or non-HAART-treated patients. MR findings were not related to immunological status, either at baseline or at follow-up. A radiological improvement within 6 months was associated with a higher probability of a more favorable clinical evolution [OR 14.0 (2.2-87.2), p = 0.003]. The overall probability of survival at 6 months was 61.5%. A better survival was observed in patients with stable or improved MR imaging findings within 6 months [HR 4.55 (95%CI 1.36-15.19, p = 0.009]. Although HAART prolonged the survival of HIV-positive patients affected by PML, it did not seem to influence the PML MR pattern of presentation and the imaging evolution. Only the radiological outcome was predictive of clinical outcome.

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