PMID- 19962769
OWN - NLM
STAT- MEDLINE
DCOM- 20100312
LR  - 20211020
IS  - 1872-8421 (Electronic)
IS  - 0165-5728 (Print)
IS  - 0165-5728 (Linking)
VI  - 219
IP  - 1-2
DP  - 2010 Feb 26
TI  - Unmasking of PML by HAART: unusual clinical features and the role of IRIS.
PG  - 100-4
LID - 10.1016/j.jneuroim.2009.11.013 [doi]
AB  - For patients with HIV/AIDS, highly active antiretroviral therapy (HAART) is 
      currently the only effective therapy for progressive multifocal 
      leukoencephalopathy (PML), a viral-induced demyelinating disease caused by 
      polyomavirus JC. Immune reconstitution inflammatory syndrome (IRIS) following 
      initiation of HAART can cause paradoxical clinical deterioration in patients with 
      established PML. Because the onset of PML follows soon after initiation of HAART 
      in some cases (unmasking), we investigated the role IRIS plays in unmasked PML. 
      We reviewed records of 20 PML cases seen from 1997-2006 at the UCSD HIV primary 
      care clinic. Eight cases presented with PML symptoms within 6months of initiating 
      HAART (referred to hereafter as unmasked PML), six patients were diagnosed with 
      PML before initiating HAART, and six were diagnosed more than 6months after 
      starting HAART. Patients with unmasked PML constituted 40% of our series, had 
      relatively long survival, and commonly (50%) had lesions exclusively in the 
      posterior fossa, a localization not previously reported with such a high 
      prevalence. Only 3 of the 8 patients with unmasked PML had IRIS reactions as 
      evidenced by contrast enhancement around lesions on MRI, suggesting that IRIS is 
      not necessary for the pathogenesis of this syndrome.
CI  - Copyright 2009 Elsevier B.V. All rights reserved.
FAU - Sidhu, Navdeesh
AU  - Sidhu N
AD  - Owen Clinic, Antiviral Research Center, and HIV Neurobehavioral Research Center, 
      University of California, San Diego, La Jolla, CA, United States. 
      nksidhu@ucsd.edu
FAU - McCutchan, J Allen
AU  - McCutchan JA
LA  - eng
GR  - T35 HL007491/HL/NHLBI NIH HHS/United States
GR  - U01 MH083506/MH/NIMH NIH HHS/United States
GR  - P30 AI036214/AI/NIAID NIH HHS/United States
GR  - U01 MH083506-01/MH/NIMH NIH HHS/United States
GR  - P30 MH062512/MH/NIMH NIH HHS/United States
GR  - T35 HL007491-26/HL/NHLBI NIH HHS/United States
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20091204
PL  - Netherlands
TA  - J Neuroimmunol
JT  - Journal of neuroimmunology
JID - 8109498
SB  - IM
MH  - Adult
MH  - Antiretroviral Therapy, Highly Active/*adverse effects
MH  - Female
MH  - HIV Infections/complications/drug therapy
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*therapy/virology
MH  - JC Virus/isolation & purification
MH  - Leukoencephalopathy, Progressive Multifocal/cerebrospinal 
      fluid/*etiology/virology
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Viral Load/methods
PMC - PMC2825275
MID - NIHMS163141
EDAT- 2009/12/08 06:00
MHDA- 2010/03/13 06:00
PMCR- 2011/02/26
CRDT- 2009/12/08 06:00
PHST- 2009/08/05 00:00 [received]
PHST- 2009/11/13 00:00 [revised]
PHST- 2009/11/18 00:00 [accepted]
PHST- 2009/12/08 06:00 [entrez]
PHST- 2009/12/08 06:00 [pubmed]
PHST- 2010/03/13 06:00 [medline]
PHST- 2011/02/26 00:00 [pmc-release]
AID - S0165-5728(09)00477-9 [pii]
AID - 10.1016/j.jneuroim.2009.11.013 [doi]
PST - ppublish
SO  - J Neuroimmunol. 2010 Feb 26;219(1-2):100-4. doi: 10.1016/j.jneuroim.2009.11.013. 
      Epub 2009 Dec 4.