Improved Survival of HIV-1-Infected Patients with Progressive Multifocal Leukoencephalopathy Receiving Early 5-Drug Combination Antiretroviral Therapy
Author Information
Author(s): Gasnault Jacques, Costagliola Dominique, Hendel-Chavez Houria, Dulioust Anne, Pakianather Sophie, Mazet Anne-Aurélie, de Goer de Herve Marie-Ghislaine, Lancar Rémi, Lascaux Anne-Sophie, Porte Lydie, Delfraissy Jean-François, Taoufik Yassine
Primary Institution: Service de Médecine Interne et de Maladies Infectieuses, Hôpital Universitaire de Bicêtre - Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, France
Hypothesis
Does early use of a five-drug combination antiretroviral therapy improve survival in HIV-1-infected patients with progressive multifocal leukoencephalopathy?
Conclusion
The early use of five-drug cART after PML diagnosis appears to improve survival.
Supporting Evidence
- The one-year survival estimate was 0.75.
- At month 12, 81% of patients had undetectable plasma HIV RNA.
- JCV DNA was undetectable in the CSF of 81% of survivors at month 6.
- Higher total and naive CD4+ T-cell counts were associated with better survival.
- JCV-specific functional memory CD4+ T-cell responses increased from 4% at baseline to 43% at month 12.
Takeaway
This study found that giving a special treatment to HIV patients with a brain disease can help them live longer.
Methodology
A multicenter, open-label pilot trial evaluating the survival benefit of a five-drug cART designed to accelerate HIV replication decay and JCV-specific immune recovery.
Potential Biases
Potential selection bias due to the open-label design.
Limitations
The study was not randomized and had a small sample size.
Participant Demographics
All participants were HIV-1 infected patients diagnosed with active PML.
Statistical Information
P-Value
0.008
Confidence Interval
0.61 to 0.93
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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