PMID- 19129505
OWN - NLM
STAT- MEDLINE
DCOM- 20090623
LR  - 20220408
IS  - 1526-632X (Electronic)
IS  - 0028-3878 (Print)
IS  - 0028-3878 (Linking)
VI  - 72
IP  - 17
DP  - 2009 Apr 28
TI  - PML-IRIS in patients with HIV infection: clinical manifestations and treatment 
      with steroids.
PG  - 1458-64
LID - 10.1212/01.wnl.0000343510.08643.74 [doi]
AB  - BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is an opportunistic 
      infection that develops in immunosuppressed patients with HIV infection. 
      Paradoxically, some of these patients may develop PML during combined 
      antiretroviral therapy in the setting of immune reconstitution. We describe the 
      types of PML in relation to immune reconstitution inflammatory syndrome (IRIS) 
      and the effects of steroid use in these patients. METHODS: We performed a 
      retrospective review of the literature (1998 to 2007) and of all HIV-infected 
      patients diagnosed with PML-IRIS at Johns Hopkins Hospital (2004 to 2007). We 
      recorded information on clinical features, microbiologic and virological 
      analysis, neuroimaging, pathology, treatment, and outcome. RESULTS: Of 54 
      patients with PML-IRIS, 36 developed PML and IRIS simultaneously (PML-s-IRIS) and 
      18 had worsening of preexisting PML (PML-d-IRIS) after the initiation of combined 
      antiretroviral therapy. PML-IRIS developed between 1 week and 26 months after 
      initiation of antiretroviral therapy. PML-d-IRIS patients developed IRIS earlier, 
      had higher lesion loads on MRI of the brain, had shorter durations of survival, 
      and had higher mortality rate compared to PML-s-IRIS patients. Twelve patients 
      received treatment with steroids, of which five died and seven showed good 
      neurologic recovery. Patients who survived had received steroids early after IRIS 
      diagnosis for longer durations and had contrast enhancement on IRIS neuroimaging. 
      CONCLUSIONS: Immune reconstitution following initiation of combined 
      antiretroviral therapy may lead to activation of an inflammatory response to 
      detectable or latent JC virus infection. Early and prolonged treatment with 
      steroids may be useful in these patients but requires further investigation.
FAU - Tan, K
AU  - Tan K
AD  - Department of Neurology, 509 Pathology, 600 N. Wolfe St., Baltimore, MD 21287, 
      USA.
FAU - Roda, R
AU  - Roda R
FAU - Ostrow, L
AU  - Ostrow L
FAU - McArthur, J
AU  - McArthur J
FAU - Nath, A
AU  - Nath A
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20090107
PL  - United States
TA  - Neurology
JT  - Neurology
JID - 0401060
RN  - 0 (Steroids)
SB  - IM
CIN - Neurology. 2009 Apr 28;72(17):1454-5. PMID: 19144930
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Antiretroviral Therapy, Highly Active/*adverse effects
MH  - Brain/drug effects/immunology/virology
MH  - Child
MH  - Drug Administration Schedule
MH  - Early Diagnosis
MH  - Female
MH  - Humans
MH  - Iatrogenic Disease/prevention & control
MH  - Immune Reconstitution Inflammatory Syndrome/chemically induced/*drug 
      therapy/*immunology
MH  - Immune System/*drug effects/immunology/physiopathology
MH  - JC Virus/drug effects/immunology
MH  - Leukoencephalopathy, Progressive Multifocal/*drug 
      therapy/*immunology/physiopathology
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Steroids/*administration & dosage/adverse effects
MH  - Treatment Outcome
MH  - Young Adult
PMC - PMC2677476
EDAT- 2009/01/09 09:00
MHDA- 2009/06/24 09:00
PMCR- 2010/04/28
CRDT- 2009/01/09 09:00
PHST- 2009/01/09 09:00 [entrez]
PHST- 2009/01/09 09:00 [pubmed]
PHST- 2009/06/24 09:00 [medline]
PHST- 2010/04/28 00:00 [pmc-release]
AID - 01.wnl.0000343510.08643.74 [pii]
AID - znl01709001458 [pii]
AID - 10.1212/01.wnl.0000343510.08643.74 [doi]
PST - ppublish
SO  - Neurology. 2009 Apr 28;72(17):1458-64. doi: 10.1212/01.wnl.0000343510.08643.74. 
      Epub 2009 Jan 7.