Incidence and prognosis of immune reconstitution inflammatory syndrome in HIV‐associated progressive multifocal leucoencephalopathy. (23rd February 2016) - Sainz‐de‐la‐Maza, S.
Abstract : Background and purpose: Progressive multifocal leucoencephalopathy‐associated immune reconstitution inflammatory syndrome (PML‐IRIS) is the paradoxical worsening or unmasking of preexisting infection with JC virus attributable to a rapid recovery of the immune system after highly active antiretroviral therapy (HAART) initiation. We investigated the incidence and factors associated with PML‐IRIS in HIV‐infected patients. We also studied its influence on mortality of PML and the effect of corticosteroid therapy. Methods: Single‐center retrospective analysis of HIV‐infected patients diagnosed with PML from 1996 to 2012 who received HAART. Results: Among 59 PML patients treated with HAART, 18 (30.51%) developed PML‐IRIS (five delayed PML‐IRIS, 13 simultaneous PML‐IRIS). Patients who developed IRIS had lower CD4 counts prior to treatment (102 vs. 68.5, P < 0.05) and experienced a greater decline in HIV‐RNA levels in response to HAART (2.5log vs. 2.95log, P < 0.05). Gadolinium enhancement on MRI was observed in 31.25% of PML‐IRIS cases versus 2.56% of PML non‐IRIS ( P < 0.01). Survival rates were higher in patients with PML‐IRIS compared to those with PML non‐IRIS. Eight patients received corticosteroids, five of which had a good outcome. Patients who died were severely ill when treatment was initiated whereas patients who survived were treated before major neurological deterioration occurred. Conclusions: Nearly one‐third of HIV‐infected patients with PML develop IRIS after initiating HAART. Patients severely immunocompromised who experience a rapid virological response to HAART have a higher risk for PML‐IRIS. There was a trend for lower mortality in patients with IRIS. Early treatment with corticosteroids might be useful.