Predictive factors for prolonged survival in acquired immunodeficiency syndrome—associated progressive multifocal leukoencephalopathy

Abstract

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 identify 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 cells/mm³ in comparison with only 1 (4.3%) of 23 short‐term survivors. Contrast enhancement on radiographic imaging was observed in 3 (50%) of 6 long‐term survivors in comparison with 4 (8.9%) of 45 short‐term survivors. Neurological 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 enhacement on computed tomographic scan or magnetic resonance imaging, and evidence of recovery of neurological function.