Acquired immunodeficiency syndrome-related progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome: prevalence, main characteristics, and outcomes in a Brazilian center

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorSANTANA, Monize Nascimento
dc.contributor.authorFERRARI, Raphaela
dc.contributor.authorMACEDO, Arthur Cassa
dc.contributor.authorMARCUSSO, Rosa Maria Nascimento
dc.contributor.authorFERNANDES, Ruan de Andrade
dc.contributor.authorVIDAL, Jose Ernesto
dc.date.accessioned2024-02-15T14:55:43Z
dc.date.available2024-02-15T14:55:43Z
dc.date.issued2023
dc.description.abstractBackground Progressive multifocal leukoencephalopathy (PML) - immune reconstitution inflammatory syndrome (IRIS) in people living with HIV/AIDS (PLWHA) has been rarely described in low- and middle-income countries.Objective To describe the prevalence of PML-IRIS among PLWHA with PML and its main features in a tertiary hospital in Brazil.Methods We performed a retrospective cohort study. We included PLWHA with PML-IRIS patients admitted at Instituto de Infectologia Emilio Ribas , Sao Paulo, Brazil, between 2011 and 2021. We retrieved information on neurological manifestations, neuroimaging findings, treatments, and outcomes.Results We identified 11 (11.8%) PML-IRIS cases among 93 patients with definite PML. Eight (73%) cases were men and had a median (IQR) age of 41 (27-50) years. Seven (63.6%) patients developed unmasking PML-IRIS and 4 (36.4%) had paradoxical PML-IRIS. The median (IQR) time from initiation of combined antiretroviral therapy (cART) to IRIS diagnosis was 49 (30-70) days. Ten (90.9%) patients received corticosteroids. There were 4 (36%) in-hospital deaths and 3 were associated with hospital-acquired pneumonia. Among the 7 (64%) patients who survived, 5 (71.5%) had sequelae at discharge. One year after the PML-IRIS diagnosis, 6 (54.5%) patients were alive.Conclusion The prevalence of PML-IRIS was 11.8%. Most patients had unmasking PML-IRIS. In-hospital mortality and morbidity were high. One-year survival was similar to that described in some high-income countries.eng
dc.description.abstractThere were 4 (36%) in-hospital deaths and 3 were associated with hospital-acquired pneumonia. Among the 7 (64%) patients who survived, 5 (71.5%) had sequelae at discharge. One year after the PML-IRIS diagnosis, 6 (54.5%) patients were alive. Conclusion The prevalence of PML-IRIS was 11.8%. Most patients had unmasking PMLIRIS. In-hospital mortality and morbidity were high. One-year survival was similar to that described in some high-income countries. Resumo Antecedentes A síndrome inflamatória de reconstituição imune (SIRI) da leucoencefalopatia multifocal progressiva (LEMP) em pessoas vivendo com HIV/Aids (PVHA) foi raramente descrita em países de baixa e média renda. Objetivo Descrever a prevalência da SIRI-LEMP- em PVHA com LEMP e suas principais características em um hospital no Brasil. Métodos Foi realizado um estudo de coorte retrospectivo. Incluímos PVHA com SIRILEMP admitidos no Instituto de Infectologia Emílio Ribas, São Paulo, Brasil, entre 2011 e 2021. Recuperamos informações sobre manifestações neurológicas, neuroimagem, tratamento e desfecho. Resultados Identificamos 11 (11,8%) casos de SIRI-LEMP entre 93 pacientes com LEMP definitiva. Oito (73%) casos eram homens e a mediana de idade (amplitude interquartile - AIQ) foi de 41 (27–50) anos. Sete (63,6%) pacientes desenvolveram SIRILEMP “desmascarada” e 4 (36,4%) casos apresentaram SIRI-LEMP “paradoxal”. A mediana de tempo (AIQ) desde o início da terapia antirretroviral combinada (cART) até o diagnóstico de SIRI foi de 49 (30–70) dias. Dez (90,9%) pacientes receberam corticoide. Houve 4 (36%) óbitos intra-hospitalares e 3 foram associados à pneumonia hospitalar. Dos 7 (64%) pacientes que sobreviveram, 5 (71,5%) ficaram com sequelas na alta. Um ano após o diagnóstico de SIRI-LEMP, 6 (54,5%) pacientes estavam vivos. Conclusão A prevalência de SIRI-LEMP foi de 11,8%. A maioria dos pacientes apresentava SIRI-LEMP “desmascarada”. A mortalidade e morbidade hospitalar foram altas. A sobrevida em 1 ano foi semelhante à descrita em alguns países de alta renda.
dc.description.indexMEDLINE
dc.description.indexPubMed
dc.description.indexWoS
dc.description.indexScopus
dc.identifier.citationARQUIVOS DE NEURO-PSIQUIATRIA, v.81, n.10, p.883-890, 2023
dc.identifier.doi10.1055/s-0043-1772831
dc.identifier.eissn1678-4227
dc.identifier.issn0004-282X
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/58197
dc.language.isopor
dc.publisherASSOC ARQUIVOS NEURO- PSIQUIATRIAeng
dc.relation.ispartofArquivos de Neuro-Psiquiatria
dc.rightsopenAccesseng
dc.rights.holderCopyright ASSOC ARQUIVOS NEURO- PSIQUIATRIAeng
dc.subjectLeukoencephalopathy, Progressive Multifocaleng
dc.subjectImmune Reconstitution Inflammatory Syndromeeng
dc.subjectEpidemiologyeng
dc.subjectHIVeng
dc.subjectBrazileng
dc.subjectLeucoencefalopatia Multifocal Progressiva
dc.subjectSíndrome Inflamatória da Reconstituição Imune
dc.subjectEpidemiologia
dc.subjectHIV
dc.subjectBrasil
dc.subject.otheractive antiretroviral therapyeng
dc.subject.othernervous-system diseaseseng
dc.subject.otherhiv-infected patientseng
dc.subject.otherrisk-factorseng
dc.subject.otherpml-iriseng
dc.subject.otherviruseng
dc.subject.othereraeng
dc.subject.othersurvivaleng
dc.subject.othermanifestationseng
dc.subject.otherepidemiologyeng
dc.subject.wosNeuroscienceseng
dc.subject.wosPsychiatryeng
dc.titleAcquired immunodeficiency syndrome-related progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome: prevalence, main characteristics, and outcomes in a Brazilian centereng
dc.title.alternativeSíndrome inflamatória de reconstituição imune da leucoencefalopatia multifocal progressiva associada à síndrome da imunodeficiência adquirida: prevalência, principais características e desfecho em um hospital brasileiro
dc.title.alternativeSíndrome inflamatória de reconstituição imune da leucoencefalopatia multifocal progressiva associada à síndrome da imunodeficiência adquirida: prevalência, principais características e desfecho em um hospital brasileiro
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.affiliation.countryCanadá
hcfmusp.affiliation.countryisoca
hcfmusp.author.externalSANTANA, Monize Nascimento:Inst Infectol Emilio Ribas, Dept Infectol, Sao Paulo, SP, Brazil
hcfmusp.author.externalFERRARI, Raphaela:Inst Infectol Emilio Ribas, Dept Infectol, Sao Paulo, SP, Brazil
hcfmusp.author.externalMACEDO, Arthur Cassa:McGill Univ, Dept Neurol & Neurosurg, Montreal, PQ, Canada
hcfmusp.author.externalMARCUSSO, Rosa Maria Nascimento:Inst Infectol Emilio Ribas, Dept Neurol, Sao Paulo, SP, Brazil
hcfmusp.author.externalFERNANDES, Ruan de Andrade:Inst Infectol Emilio Ribas, Dept Infectol, Sao Paulo, SP, Brazil
hcfmusp.citation.scopus0
hcfmusp.contributor.author-fmusphcJOSE ERNESTO VIDAL BERMUDEZ
hcfmusp.description.beginpage883
hcfmusp.description.endpage890
hcfmusp.description.issue10
hcfmusp.description.volume81
hcfmusp.origemWOS
hcfmusp.origem.pubmed37899047
hcfmusp.origem.scopus2-s2.0-85176509566
hcfmusp.origem.wosWOS:001093382000003
hcfmusp.publisher.citySAO PAULO SPeng
hcfmusp.publisher.countryBRAZILeng
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