Journal Article

Risk of Progressive Multifocal Leukoencephalopathy in the Combination Antiretroviral Therapy Era in the French Hospital Database on Human Immunodeficiency Virus (ANRS-C4)

Joly, Véronique, Gasnault, Jacques, Guiguet, Marguerite, De Truchis, Pierre, Khuong-Josses, Marie-Aude, Bocket, Laurence, Katlama, Christine, Canestri, Anna, Risso, Karine, Robineau, Olivier, Henn, Aurelia, Revest, Matthieu, Costagliola, Dominique, Melliez, Hugues, Martin-Blondel, Guillaume, Abgrall, Sophie, Mary-Krause, Murielle, De Castro, Nathalie, Mokhtari, Saadia

2018

Overview

We studied risk factors for progressive multifocal leukoencephalopathy in human immunodeficiency virus-infected individuals. Recent combination antiretroviral therapy initiation was associated with a transient increase in the risk of progressive multifocal leukoencephalopathy. Injection drug users and hepatitis C virus-seropositive individuals were at a higher risk, while sub-Saharan African origin was not protective. Abstract Background Risk factors for progressive multifocal leukoencephalopathy (PML) in individuals with human immunodeficiency virus (HIV) infection are poorly documented in the era of combination antiretroviral therapy (cART). Methods We studied HIV-1-infected individuals aged ≥15 years who had no history of PML and were prospectively followed up between 1997 and 2011 in the French Hospital Database on HIV (FHDH-ANRS CO4) cohort. Cox models were used to calculate adjusted hazard ratios (HRs), focusing on sub-Saharan origin, suggested to be protective, and recent cART initiation, potentially associated with an increased risk of PML. Results PML developed in 555 individuals, in 57 during the first 6 months of cART. From 1997-2000 to 2009-2011, the incidence fell from 1.15 (95% confidence interval [CI], .98-1.31) to 0.49 (.37-.61) per 1000 person-years. Sub-Saharan African origin had no clear influence (HR, 0.80; 95% CI, .58-1.11). Compared with men who have sex with men, injection drug users (IDUs) were at higher risk (HR, 1.80 [95% CI, 1.32-2.45] for male and 1.68 [1.13-2.48] for female IDUs). When IDUs were excluded, hepatitis C virus seropositivity was associated with an increased risk (HR, 1.40; 95% CI, 1.02-1.93). Compared with no cART initiation, initiation <6 months previously was associated with PML onset (HR, 4.91; 95% CI, 2.42-9.95). Conclusions Recent cART initiation is associated with an increased risk of PML, as are injection drug use and hepatitis C virus seropositivity. Sub-Saharan African origin had no protective effect.

• Publisher: Oxford University Press,Oxford University Press (OUP)
• Subject: Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Confidence intervals / Drug abuse / Drug therapy / Encephalitis / Hepatitis / Hepatitis C / HIV / Human health and pathology / Human immunodeficiency virus / Injection / Leukoencephalopathy / Life Sciences / Progressive multifocal leukoencephalopathy / Risk analysis / Risk factors / Sexually transmitted diseases / STD / Therapy / Viral infections / Viruses