| Publication Abstract Display | | Type: Poster | | Title: Characteristics of a large pediatric progressive multifocal leucoencepthalopathy cohort with parenterally acquired HIV-1 infection. | | Authors: Duiculescu D, Ene L, Radoi R, Smith D, Achim C | | Date: 02-28-2011 | | Abstract:Background: Progressive multifocal leucoencephalopathy (PML) is not common in HIV-1 infected children. In Romania we have a unique cohort of children infected by parenteral route with HIV-1 clade F, during their first year of life. We found in this cohort a high prevalence of opportunistic HIV-related neurological complications, including PML. We aim to characterize a large single-centre pediatric cohort with PML and to evaluate the factors associated with survival.
Patients and methods: The study group includes children and adolescents diagnosed with PML between 1997-2010. The PML diagnosis was established based on clinical symptoms, neuroimaging, cerebrospinal fluid (CSF) findings and neurohistologic examination. The variables analyzed in order to evaluate their relationship with survival include: age, previous exposure to combined antiretroviral treatment (cART), CD4 counts, HIV RNA load (plasma and CSF), the characteristics of demielinating lesions, previous exposure to ART, and ART penetrability score in CSF.
Results: PML was diagnosed in 27 (9.74%) out of 277 patients neuro-AIDS defining diseases. The patients (15 boys, 12 girls), were 14.1± 4.1 years old, and 18 of them were naive to cART. All patients had severe immune suppression with a median CD4 count of 30 (range 0-194)) cells/ml. The CSF HIV RNA load was lower compared to plasma (3.06±1.03 vs. 4.9±1.3 log10 copies/ml) p=0.0001. Six of 16 patients had subtentorial lesions exclusively. The PML diagnosis was confirmed by histology in 2 autopsy studies and by in situ hybridisation in 1 patient. In 21 patients the diagnosis was confirmed by PCR. The mortality rate was 57.7%. The median survival period was 3.6 months, with a survival probability at 12 months of 37.3%. The only factor associated with long-term survival by univariate Cox regression was cART (p=0.05). Survival among children who have received cART was associated with higher CSF antiretroviral penetrability score (p=0.05) and with higher age (p=0.03) at the time of PML diagnosis.
Conclusion: We believe this is the largest pediatric cohort with PML described to date. The main features of this cohort are the parenteral transmission of HIV-1, the possible association of clade F with high prevalence of PML, and the subtentorial location of the lesions. Factors associated with longer survival were cART with higher CSF penetrability score and older age of the children. |
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