Progressive multifocal leukoencephalopathy in HIV-1 infection

Summary Progressive multifocal leukoencephalopathy is caused by the JC polyomavirus (JCV) and is one of the most feared complications of HIV-1 infection. Unlike other opportunistic infections, this disease can present when CD4 counts are higher than those associated with AIDS and when patients are r...

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Bibliographic Details
Published in:The Lancet infectious diseases 2009-10, Vol.9 (10), p.625-636
Main Authors: Cinque, Paola, Dr, Koralnik, Igor J, MD, Gerevini, Simonetta, MD, Miro, Jose M, MD, Price, Richard W, MD
Format: Article
Language:English
Subjects:
Biological and medical sciences
Cerebrospinal Fluid - virology
HIV Infections - complications
Human immunodeficiency virus 1
Human viral diseases
Humans
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Infectious Disease
Infectious diseases
JC virus
JC Virus - isolation & purification
Leukoencephalopathy, Progressive Multifocal - diagnosis
Leukoencephalopathy, Progressive Multifocal - epidemiology
Leukoencephalopathy, Progressive Multifocal - pathology
Leukoencephalopathy, Progressive Multifocal - therapy
Medical sciences
Polyomavirus
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
Viral diseases of the nervous system
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Summary:Summary Progressive multifocal leukoencephalopathy is caused by the JC polyomavirus (JCV) and is one of the most feared complications of HIV-1 infection. Unlike other opportunistic infections, this disease can present when CD4 counts are higher than those associated with AIDS and when patients are receiving combined antiretroviral therapy, either shortly after starting or, more rarely, during long term successful treatment. Clinical suspicion of the disease is typically when MRI shows focal neurological deficits and associated demyelinating lesions; however, the identification of JCV in cerebrospinal fluid or brain tissue is needed for a definitive diagnosis. Although no specific treatment exists, the reversal of immunosuppression by combined antiretroviral therapy leads to clinical and MRI stabilisation in 50–60% of patients with the disease, and JCV clearance from cerebrospinal fluid. A substantial proportion of patients treated with combined antiretroviral therapy develop inflammatory lesions, which can be associated with either a favourable outcome or clinical worsening. The reasons for variability in the natural history of progressive multifocal leukoencephalopathy and treatment responses are largely undefined, and more specific and rational approaches to management are needed.
ISSN:1473-3099
1474-4457
DOI:10.1016/S1473-3099(09)70226-9