J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 3, Number 1, February 2011, pages 17-22

From Clinical Presentation to the Outcome: the Natural History of PML in a Portuguese Population of HIV Infected Patients

**Table 1.** Clinical and Biological Features and Outcome of 25 AIDS-Associated PML Patients
Patients	Sex	Route of transmission	Year of PML diagnosis	Age at PML diagnosis	Time between HIV and PML diagnosis (months)	CD4 count at onset of PML (cells/μl)	HIV viral load	Main clinical symptoms	Antiretroviral therapy before PML	Treatment started after PML	Clinical evolution	Time of follow up (months)	Main event/Outcome
M - Male, F - Female, Unk - Unknown, AZT - Zidovudine, 3TC - Lamivudine, NVP - Nevirapine, RTV - Ritonavir, FPV - Fosamprenavir, IDV - Indinavir, NFV - Nelfinavir, LPV - Lopinavir, EFV - Efavirenz
1	M	Drug abuse	2009	32	3	122	13000	Convulsions, gait ataxia, unilateral paresis	None	AZT/3TC/NVP	Worse/progression	4	Dead (bacterial pneumonia)
2	M	Drug abuse	2007	45	96	76	7517	Convulsions	None	AZT/3TC/RTV/FPV	Partial recovery	31	Dead (pneumonia H1N1)
3	M	Drug abuse	1997	35	0	183	13580	Sensitivity disturbance, unilateral paresis	None	AZT/3TC/IDV	Total recovery	139	Dead (car accident with polytrauma)
4	M	Sexual	1997	43	0	73	Unk	Cognitive/behavioral disturbance, speech disorder, unilateral paresis	None	AZT/3TC/IDV	Same state	11	Lost
5	M	BM transplant	1995	18	94	94	Unk	Unilateral paresis	AZT	AZT	Worse/progression	5	Dead (PML progression)
6	M	Sexual	1999	49	0	14	> 500000	Speech disorder, unilateral paresis	None	AZT/3TC/NFV	Same state	0.75	Lost
7	M	Sexual	1992	34	3	8	Unk	Headache, sensitivity disturbance, unilateral paresis	None	None	Worse/progression	1	Dead (PML progression)
8	M	Drug abuse	1995	31	7	30	Unk	Sensitivity disturbance, unilateral paresis	AZT	AZT	Same state	2	Dead (bacterial pneumonia)
9	M	Sexual	1992	32	60	3	Unk	Sensitivity disturbance, unilateral paresis	AZT	AZT	Worse/progression	1	Dead (bacterial pneumonia)
10	F	Sexual	1993	29	47	24	Unk	Speech disorder, unilateral paresis	None	AZT	Partial recovery	1	Lost
11	M	Drug abuse	1999	43	0	127	57533	Visual and speech disorder, unilateral paresis	None	AZT/3TC/IDV	Total recovery	131	Alive
12	M	Drug abuse	1997	39	1	13	Unk	Cognitive/behavioral and visual disturbance, unilateral paresis	AZT/3TC/IDV	AZT/3TC/IDV	Same state	0.75	Dead (bacterial pneumonia)
13	M	Sexual	1998	58	0	63	Unk	Speech disorder, unilateral paresis	None	AZT/3TC/IDV	Worse/progression	1	Lost
14	M	Sexual	2008	23	0	55	76621	Convulsions	None	AZT/3TC/NVP	Partial recovery	28	Alive
15	M	Sexual	2004	27	1.5	34	Unk	Visual disorder, gait ataxia, bilateral paresis	AZT/3TC/IDV/LPV/RTV	AZT/3TC/IDV/LPV/RTV	Worse/progression	1	Lost
16	M	Drug abuse	2001	35	0	132	Unk	Convulsions	None	AZT/3TC/NFV	Same state	20	Lost
17	M	Drug abuse	2003	36	42	5	Unk	Cognitive/behavioral disturbance	None	AZT/3TC/NFV/NVP	Worse/progression	0.6	Dead (bacterial pneumonia)
18	M	Sexual	2001	48	0	14	73024	Cognitive/behavioral disturbance	None	AZT/3TC/NVP/NFV	Worse/progression	8	Dead (systemic cryptococcosis)
19	F	Sexual	2002	53	Unk	580	Unk	Cognitive/behavioral disturbance, unilateral paresis	Unknown	Continuation of the same therapy	Worse/progression	0	Dead (PML progression)
20	M	Sexual	2006	41	0	184	406979	Speech disorder, unilateral paresis	None	AZT/3TC/EFV	Worse/progression	4	Dead (PML progression)
21	M	Sexual	2001	57	5	173	Unk	Speech disorder, convulsions, unilateral paresis	None	AZT/3TC/IDV	Partial recovery	84	Dead (bacterial pneumonia)
22	M	Drug abuse	2001	30	0.5	42	Unk	Bilateral paresis	None	AZT/3TC/IDV	Partial recovery	105	Alive
23	M	Sexual	2007	44	0	111	31239	Cognitive and speech disturbance	None	AZT/3TC/FPV/RTV	Same state	1	Lost
24	F	Drug abuse	1995	40	0	175	Unk	Headache, unilateral paresis	None	AZT	Worse/progression	60	Lost
25	F	Sexual	2009	47	129	717	< 20	Speech disorder, gait ataxia	AZT/3TC/EFV	ABA/3TC/EFV	Worse/progression	11	Dead (PML progression)

Table 1. Clinical and Biological Features and Outcome of 25 AIDS-Associated PML Patients

Patients

Sex

Route of transmission

Year of PML diagnosis

Age at PML diagnosis

Time between HIV and PML diagnosis (months)

CD4 count at onset of PML (cells/μl)

HIV viral load

Main clinical symptoms

Antiretroviral therapy before PML

Treatment started after PML

Clinical evolution

Time of follow up (months)

Main event/Outcome

M - Male, F - Female, Unk - Unknown, AZT - Zidovudine, 3TC - Lamivudine, NVP - Nevirapine, RTV - Ritonavir, FPV - Fosamprenavir, IDV - Indinavir, NFV - Nelfinavir, LPV - Lopinavir, EFV - Efavirenz

Drug abuse

2009

122

13000

Convulsions, gait ataxia, unilateral paresis

None

AZT/3TC/NVP

Worse/progression

Dead (bacterial pneumonia)

Drug abuse

2007

7517

Convulsions

None

AZT/3TC/RTV/FPV

Partial recovery

Dead (pneumonia H1N1)

Drug abuse

1997

183

13580

Sensitivity disturbance, unilateral paresis

None

AZT/3TC/IDV

Total recovery

139

Dead (car accident with polytrauma)

Sexual

1997

Unk

Cognitive/behavioral disturbance, speech disorder, unilateral paresis

None

AZT/3TC/IDV

Same state

Lost

BM transplant

1995

Unk

Unilateral paresis

AZT

Worse/progression

Dead (PML progression)

Sexual

1999

> 500000

Speech disorder, unilateral paresis

None

AZT/3TC/NFV

Same state

0.75

Lost

Sexual

1992

Unk

Headache, sensitivity disturbance, unilateral paresis

None

Worse/progression

Dead (PML progression)

Drug abuse

1995

Unk

Sensitivity disturbance, unilateral paresis

AZT

Same state

Dead (bacterial pneumonia)

Sexual

1992

Unk

Sensitivity disturbance, unilateral paresis

AZT

Worse/progression

Dead (bacterial pneumonia)

Sexual

1993

Unk

Speech disorder, unilateral paresis

None

AZT

Partial recovery

Lost

Drug abuse

1999

127

57533

Visual and speech disorder, unilateral paresis

None

AZT/3TC/IDV

Total recovery

131

Alive

Drug abuse

1997

Unk

Cognitive/behavioral and visual disturbance, unilateral paresis

AZT/3TC/IDV

Same state

0.75

Dead (bacterial pneumonia)

Sexual

1998

Unk

Speech disorder, unilateral paresis

None

AZT/3TC/IDV

Worse/progression

Lost

Sexual

2008

76621

Convulsions

None

AZT/3TC/NVP

Partial recovery

Alive

Sexual

2004

1.5

Unk

Visual disorder, gait ataxia, bilateral paresis

AZT/3TC/IDV/LPV/RTV

Worse/progression

Lost

Drug abuse

2001

132

Unk

Convulsions

None

AZT/3TC/NFV

Same state

Lost

Drug abuse

2003

Unk

Cognitive/behavioral disturbance

None

AZT/3TC/NFV/NVP

Worse/progression

0.6

Dead (bacterial pneumonia)

Sexual

2001

73024

Cognitive/behavioral disturbance

None

AZT/3TC/NVP/NFV

Worse/progression

Dead (systemic cryptococcosis)

Sexual

2002

Unk

580

Unk

Cognitive/behavioral disturbance, unilateral paresis

Unknown

Continuation of the same therapy

Worse/progression

Dead (PML progression)

Sexual

2006

184

406979

Speech disorder, unilateral paresis

None

AZT/3TC/EFV

Worse/progression

Dead (PML progression)

Sexual

2001

173

Unk

Speech disorder, convulsions, unilateral paresis

None

AZT/3TC/IDV

Partial recovery

Dead (bacterial pneumonia)

Drug abuse

2001

0.5

Unk

Bilateral paresis

None

AZT/3TC/IDV

Partial recovery

105

Alive

Sexual

2007

111

31239

Cognitive and speech disturbance

None

AZT/3TC/FPV/RTV

Same state

Lost

Drug abuse

1995

175

Unk

Headache, unilateral paresis

None

AZT

Worse/progression

Lost

Sexual

2009

129

717

< 20

Speech disorder, gait ataxia

AZT/3TC/EFV

ABA/3TC/EFV

Worse/progression

Dead (PML progression)

**Table 2.** Differences Between Pre-HAART and Post-HAART Era Concerning CD4 T Cell Count, Age of Diagnosis (PML and HIV) and Death Causes
Characteristic	All (n = 25)	PML diagnosis
Gender	4 female, 21 male	2 female, 4 male	2 female, 17 male
CD4+ cell count at diagnosis, median (IQR), cell/μl	73 (19 - 152.5)	27 (6.75 - 114.25)	76 (34 - 173)
Age at HIV diagnosis, median (IQR), years	35.5 (30.25 - 43.0)	29 (20.75 - 34.75)	37.5 (32.75 - 45)
Age at PML diagnosis, median (IQR), years	39.0 (31.5 - 46.0)	31.5 (26.25 - 31.5)	43.0 (35.0 - 48.0)
Time between HIV and PML diagnosis, median (IQR), months	0.75 (0.0 - 33.25)	27.0 (2.25 - 68.5)	0.0 (0 - 3.5)
Death (all causes)	14	4	10
Death (attributed to PML progression)	5	2 (50%)	3 (30%)

Table 2. Differences Between Pre-HAART and Post-HAART Era Concerning CD4 T Cell Count, Age of Diagnosis (PML and HIV) and Death Causes

Characteristic

All (n = 25)

PML diagnosis

Before 1997 (n = 6)

1997 - 2009 (n = 19)

Gender

4 female, 21 male

2 female, 4 male

2 female, 17 male

CD4+ cell count at diagnosis, median (IQR), cell/μl

73 (19 - 152.5)

27 (6.75 - 114.25)

76 (34 - 173)

Age at HIV diagnosis, median (IQR), years

35.5 (30.25 - 43.0)

29 (20.75 - 34.75)

37.5 (32.75 - 45)

Age at PML diagnosis, median (IQR), years

39.0 (31.5 - 46.0)

31.5 (26.25 - 31.5)

43.0 (35.0 - 48.0)

Time between HIV and PML diagnosis, median (IQR), months

0.75 (0.0 - 33.25)

27.0 (2.25 - 68.5)

0.0 (0 - 3.5)

Death (all causes)

Death (attributed to PML progression)

2 (50%)

3 (30%)