Caleb R S McEntire1, Kathryn T Fong2, Dan Tong Jia3, Ellen R Cooper4, Anna M Cervantes-Arslanian5, Farrah J Mateen6, Pria Anand5, Kiran T Thakur2. 1. Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts. 2. Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York. 3. Department of Neurology, Northwestern Memorial Hospital, Chicago, Illinois. 4. Department of Pediatrics, Boston University School of Medicine. Division of Infectious Diseases, Boston Medical Center. 5. Departments of Neurology, Neurosurgery, and Medicine (Infectious Disease), Boston Medical Center. 6. Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Abstract
OBJECTIVE: The aim of this study was to describe the natural history of individuals with congenital HIV who develop JC virus (JCV) infection of the central nervous system (CNS). METHODS: We retrospectively evaluated individuals with congenital HIV who met criteria for progressive multifocal leukoencephalopathy (PML) or JCV granule cell neuronopathy (JCV GCN) at three major healthcare centres in the northeast USA. Data on adherence to combined antiretroviral therapy (cART), neurologic symptoms, serum markers of immunity and HIV infection, cerebrospinal fluid (CSF) analyses, radiographic features, modified Rankin Scale (mRS) scores and survival were collected from the electronic medical record up to a censoring date of 1 August 2020. RESULTS: Among 10 adults with congenitally acquired HIV, nine were diagnosed with definitive PML and one was diagnosed with probable JCV GCN. Individuals presented at the time of their PML or JCV GCN diagnosis with a mean mRS of 2.0 (standard deviation 1.0). A premorbid mRS was documented for six patients and was zero in all cases. The most common risk factor was confirmed cART nonadherence in nine individuals. Five individuals with PML and one with JCV GCN died, with a latency from symptom onset to death of approximately 3 months for three individuals, and approximately 2 years for the remaining two. CONCLUSION: Youth-adulthood transition is a high-risk point for dropping off from medical care. The study of this timepoint in people living with HIV could help inform effective care in these individuals.
OBJECTIVE: The aim of this study was to describe the natural history of individuals with congenital HIV who develop JC virus (JCV) infection of the central nervous system (CNS). METHODS: We retrospectively evaluated individuals with congenital HIV who met criteria for progressive multifocal leukoencephalopathy (PML) or JCV granule cell neuronopathy (JCV GCN) at three major healthcare centres in the northeast USA. Data on adherence to combined antiretroviral therapy (cART), neurologic symptoms, serum markers of immunity and HIV infection, cerebrospinal fluid (CSF) analyses, radiographic features, modified Rankin Scale (mRS) scores and survival were collected from the electronic medical record up to a censoring date of 1 August 2020. RESULTS: Among 10 adults with congenitally acquired HIV, nine were diagnosed with definitive PML and one was diagnosed with probable JCV GCN. Individuals presented at the time of their PML or JCV GCN diagnosis with a mean mRS of 2.0 (standard deviation 1.0). A premorbid mRS was documented for six patients and was zero in all cases. The most common risk factor was confirmed cART nonadherence in nine individuals. Five individuals with PML and one with JCV GCN died, with a latency from symptom onset to death of approximately 3 months for three individuals, and approximately 2 years for the remaining two. CONCLUSION: Youth-adulthood transition is a high-risk point for dropping off from medical care. The study of this timepoint in people living with HIV could help inform effective care in these individuals.
Authors: Allison L Agwu; Lana Lee; John A Fleishman; Cindy Voss; Baligh R Yehia; Keri N Althoff; Richard Rutstein; W Christopher Mathews; Ank Nijhawan; Richard D Moore; Aditya H Gaur; Kelly A Gebo Journal: J Adolesc Health Date: 2015-03 Impact factor: 5.012
Authors: Martijn T Wijburg; Bob W van Oosten; Jean-Luc Murk; Ouafae Karimi; Joep Killestein; Mike P Wattjes Journal: J Neurol Date: 2014-10-09 Impact factor: 6.682