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Clinical profile and outcome in AIDS related progressive multifocal leukoencephalopathy — A large cohort from India

      Background: Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection by JC virus seen in immunodeficient individuals, especially those with AIDS. Poor outcome despite highly active antiretroviral therapy is a cause of concern.
      Objective: This study was undertaken to assess the clinical profile and survival in patients with PML.
      Patients and methods: Data of AIDS patients with laboratory confirmed PML (JC virus positive) and possible PML (clinicoradiological) from 2004 were studied. Demographic profile, clinical assessment, laboratory parameters and outcome were analyzed.
      Results: Study group included 33 patients (25 men; 8 women) with age ranging from 26 to 67 years (39.48 ± 9.11). Symptom duration was 47.15 ± 55.63 days. Presenting symptoms were limb weakness (18), cognition and behavioral changes (13), aphasia/dysarthria (12), gait ataxia (7), seizures (6), impaired vision (5), impaired consciousness (5), sensory disturbance (3), involuntary movement (2) and Gerstmann syndrome (1). PML was the presenting manifestation of immunodeficiency in 7 patients. 18 patients were on HAART. Radiological lesions were present in supratentorial white matter in 29 patients (bilateral 21, unilateral 8). Six had brainstem lesions and 5 had cerebellar involvement. Five patients had lesions in supra and infratentorial compartment. CSF was acellular in 15 while 14 had elevated protein. Laboratory confirmation of JC virus was available in 4 patients. Fourteen patients were lost for follow-up and 15 (6 women; 9 men) succumbed. Follow-up on surviving 4 patients who remained neurologically static on HAART was 12 to 96 months (median 43).
      Conclusion: This is a descriptive study of large cohort of PML patients from a single center. 21% of the patients had PML as the presenting manifestation of AIDS.