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

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.

• Authors: Hugues Melliez, Murielle Mary-Krause, Laurence Bocket, Marguerite Guiguet, Sophie Abgrall, Pierre De Truchis, Christine Katlama, Guillaume Martin-Blondel, Aurelia Henn, Matthieu Revest, Olivier Robineau, Marie-Aude Khuong-Josses, Anna Canestri, Nathalie De Castro, Véronique Joly, Saadia Mokhtari, Karine Risso, Jacques Gasnault, Dominique Costagliola, French Hospital Database on HIV (ANRS-C4)
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 67 Issue 2 Pg. 275-282 (07 02 2018) ISSN: 1537-6591 [Electronic] United States
• PMID: 29635465 (Publication Type: Journal Article)

Chemical References

• Anti-HIV Agents

Topics

• Adult
• Anti-HIV Agents (adverse effects, therapeutic use)
• Databases, Factual
• Drug Therapy, Combination
• Female
• France
• HIV Infections (complications, drug therapy)
• HIV-1
• Hepatitis C (complications)
• Homosexuality, Male
• Hospitals
• Humans
• Incidence
• Leukoencephalopathy, Progressive Multifocal (etiology)
• Male
• Proportional Hazards Models
• Prospective Studies
• Risk Factors
• Sexual and Gender Minorities
• Substance Abuse, Intravenous (complications)