HIV-associated progressive multifocal leukoencephalopathy: current perspectives

• Published in: Neurobehavioral HIV medicine Vol. 7; pp. 43 - 52
• Main Authors: Iannetta, Marco, Ciardi, Maria Rosa, Zingaropoli, Maria Antonella, D'Abramo, Alessandra, Oliva, Alessandra, Mastroianni, Claudio Maria, Vullo, Vincenzo
• Format: Journal Article
• Language: English
• Published: Macclesfield Dove Medical Press Limited 2016; Taylor & Francis Ltd
• Subjects: Acquired immune deficiency syndrome; AIDS; Antigens; Antiretroviral agents; Binding sites; Central nervous system; Demyelinating diseases; Demyelination; Deoxyribonucleic acid; DNA; Dosage and administration; Drug therapy; Encephalitis; Epidemiology; Genomes; Health care; HIV; Human immunodeficiency virus; Immune system; Leukoencephalopathy; Monoclonal antibodies; Patients; Progressive multifocal leukoencephalopathy; Proteins; Risk factors; Transplants & implants; Urine; Viral infections
• ISSN: 1179-1497; 1179-1497
• DOI: 10.2147/NBHIV.S107941

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system, caused by the polyomavirus JC and occurring almost exclusively in the context of severe immune depression. AIDS represents the most common predisposing condition for PML development. Antiretroviral treatment has reduced PML incidence in HIV-infected subjects, but the disease remains a severe and life-threatening complication of AIDS, considering thus far the lack of an effective anti-JC virus (JCV) direct-acting antiviral drug. In the last decade, the use of monoclonal antibodies for treating immune-based diseases evidenced new predisposing conditions for PML development, promoting a renewed interest in PML pathogenesis. In this article, we review the current knowledge on JCV epidemiology and AIDS-associated PML incidence, JCV viral cycle, pathogenesis, and the interplay with HIV infection. We give an updated overview of diagnostic and prognostic tools available for PML diagnosis and describe past and current therapeutic approaches, including new strategies for PML cure.