Rare cases of PML diagnosed at CD4 >200 with undetectable viral load

Simon Collins, HIV i-Base

Although progressive multifocal leukoencephalopathy (PML) is now uncommon, a review published in AIDS reports rare cases from a large French of PML at higher CD4 counts and with undetectable viral load.

From 571 cases of PML reported in the Dat’AIDS cohort between 2000 and 2019, 10 cases (1.75%) occurred at a CD4 cell count >200 cells/mm³ and an undetectable HIV RNA viral load after at least 6 months of ART.

Median CD4 cell count at PML diagnosis was 395 cells/mm³ [IQR: 310 to 477]. The median time of undetectable HIV viral load was 41 months (IQR: 8 to 67).

Other details include that: “only one person treated with rituximab-based chemotherapy for a large B-cell lymphoma had an established risk factor for PML. Among the nine others, multiple factors of impaired immunity could have led to PML: HCV co-infection (n=6), cirrhosis (n=4), HHV-8 co-infection (n=3) with Kaposi’s sarcoma (n=2) in association with Castleman’s disease (n=1) and indolent IgA multiple myeloma (n=1).

Reference

Dalla-Pozza P et al. Progressive multifocal leukoencephalopathy in patients with immuno-virological control and at least 6 months of combination antiretroviral therapy. AIDS, doi: 10.1097/QAD.0000000000003145. (6 December 2021).
https://journals.lww.com/aidsonline/Abstract/9000/Progressive_multifocal_leukoencephalopathy_in.96259.aspx