ABSTRACT
Objective:
To investigate the clinical manifestations, imaging findings, characteristics of
cerebrospinal fluid,
treatment and
prognosis in
patients with
acquired immune deficiency syndrome (
AIDS)-related
progressive multifocal leukoencephalopathy (PML) diagnosed by second generation sequencing
techniques with
cerebrospinal fluid.
Methods:
From October, 2017 to January, 2019, ten
patients with
AIDS-related PML were diagnosed by second generation sequencing
techniques with
cerebrospinal fluid, and their clinical data were retrospectively reviewed. Descriptive
analysis was used.
Results:
Among the ten
patients with
AIDS-related PML, eight were
males and two were
females. The age was (38.7±8.2) years. The median CD4 +
T lymphocyte count was 46/μL. The median
human immunodeficiency virus (
HIV)
RNA was 5.99×10 4copies/mL. The main clinical manifestations included
dyskinesia in four
patients,
dizziness in three
patients,
cognitive decline in two
patients, and
speech disorder in one
patient. Three
patients developed convulsion throughout the
course of the
disease. Image findings indicated that lesions could appear in any part, including lesions located under the tentorium of
cerebellum in three cases, and above the
cerebellum in seven cases. Mild increase of total
protein was observed in the
cerebrospinal fluid of four cases, while
white blood cell count ((0-10)×10 6/L),
sugar and
chloride were normal in all cases. The reads of
JC virus sequence in the
cerebrospinal fluid ranged from 3-12 531 reads (median 67 reads). All the
patients received
antiviral therapy containing
integrase inhibitors. Among the 10
patients, two died in
hospital and eight survived, and two of them had survived for more than one year. The symptoms were improved in five
patients and unchanged in three
patients.
Conclusions:
PML is less common in
patients with
HIV/
AIDS. The second generation sequencing
techniques with
cerebrospinal fluid can help to
diagnose the
disease together with clinical manifestations, routine
detection of
cerebrospinal fluid and imaging. Potent antiretroviral
treatment may improve the
prognosis of the
patients.