Journal of NeuroVirology

, Volume 7, Issue 4, pp 364–368

Potent anti-retroviral therapy with or without cidofovir for AIDS-associated progressive multifocal leukoencephalopathy: Extended follow-up of an observational study

  • Andrea De Luca
  • Maria Letizia Giancola
  • Adriana Ammassari
  • Susanna Grisetti
  • Antonella Cingolani
  • Dora Larussa
  • Lucia Alba
  • Rita Murri
  • Giuseppe Ippolito
  • Roberto Cauda
  • Antonella d’Arminio Monforte
  • Andrea Antinori
Clinical Trial Report

DOI: 10.1080/13550280152537256

Cite this article as:
De Luca, A., Giancola, M.L., Ammassari, A. et al. Journal of NeuroVirology (2001) 7: 364. doi:10.1080/13550280152537256

Abstract

To analyze the clinical efficacy of cidofovir combined with highly active anti-retroviral therapy (HAART) in AIDS-related progressive multifocal leukoen-cepalopathy (PML), a multicenter observational study was performed. Consecutive HIV-positive patients with histologically or virologically proven PML and at least 4 weeks of treatment after diagnosis were examined: 27 patients were treated with HAART, whereas 16 patients were treated with HAART plus cidofovir 5 mg/kg intravenously per week for the first 2 weeks and every other week thereafter. JC virus DNA was quantified in cerebrospinal fluid (CSF) by PCR. Baseline virologic, immunologic, and clinical characteristics as well as HIV RNA and CD4 responses to HAART were homogeneous between the groups. The median follow-up was 132 weeks. In one case (6%), cidofovir was permanently discontinued because of severe proteinuria. One-year cumulative probability of survival was 0.61 with cidofovir and 0.29 without (log rank test P = 0.02). After adjusting for baseline CD4 counts, JC viral load in CSF, Karnofsky, and use of HAART prior to the onset of PML, the use of cidofovir was independently associated with a reduced risk of death (hazard ratio, 0.21, 95% confidence interval, 0.07–0.65; P = 0.005). A randomized study will definitively establish whether cidofovir confers significant advantage over HAART alone in AIDS-related PML.

Keywords

PML brain opportunistic infections viral infections anti-retroviral therapy antiviral therapy 

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Copyright information

© Journal of NeuroVirology, Inc. 2001

Authors and Affiliations

  • Andrea De Luca
    • 1
  • Maria Letizia Giancola
    • 2
  • Adriana Ammassari
    • 1
  • Susanna Grisetti
    • 2
  • Antonella Cingolani
    • 1
  • Dora Larussa
    • 1
  • Lucia Alba
    • 2
  • Rita Murri
    • 1
  • Giuseppe Ippolito
    • 2
  • Roberto Cauda
    • 1
  • Antonella d’Arminio Monforte
    • 3
  • Andrea Antinori
    • 2
  1. 1.Department of Clinical Infectious DiseasesUniversità Cattolica del S CuoreRomeItaly
  2. 2.National Institute for Infectious Diseases Lazzaro Spallanzani IRCCSRomeItaly
  3. 3.Institute of Infectious and Tropical DiseasesUniversity of Milan, L Sacco HospitalMilanItaly
  4. 4.Istituto di Clinica delle Malattie InfettiveUniversità Cattolica del S. Cuore, Largo F. VitoRomaItaly

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