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Progressive multifocal leukoencephalopathy(PML)complicating the acquired immunodeficiency syndrome(AIDS)is typically inexorably progressive with death usually occurring within 6 months of symptom onset.Occasional patients have been observed to survive longer than 1 year,often with remission of clinical features.In this study,we identified predictive factors for prolonged survival in patients with biopsy proven,AIDS- associated PML,by comparing 7 patients with survival exceeding 12 months from symptom onset with 45 patients with shorter survivals.PML was the presenting manifestation of AIDS in 5(71.4%)of 7 long-term survivors compared with 8(17.8%)of 45 short-term survivors.CD4 T-lymphocyte counts were substantially higher in the long-term survivors,with 3(42.9%)of 7 having counts exceeding 300 cell/mm3 in comparison with only 1(4.3%)of 23 short-term survivors.Contrast enhancement on radiographic image was observed in 3(50%)of 6 long-term survivors in comparison with 4(8.9%)of 45 short-term survivors.Neurologically recovery and radiographic improvement were not observed in any short-term survivors but were seen in 5(71.4%) long-term survivors.There was no association between treatment modalities and survival.Predictors of long-term survival in AIDS patients with PML include PML as the heralding manifestation of AIDS,high CD4 T-lymphocyte count at disease onset,lesion enhancement on computed tomographic scan or magnetic resonance imaging,and evidence of recovery of neurological function. |
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acquired immunodeficiency syndrome
acquired immunodeficiency syndrome,heralded by neurologic invol
CAT scan
CAT scan,contrast enhanced
CD4 counts
highly active antiretroviral therapy
human immunodeficiency virus type 1
life expectancy
MRI
MRI,abnormal
MRI,contrast enhanced
prognosis
progressive multifocal leucoencephalopathy
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