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HIV-associated progressive multifocal leukoencephalopathy: current perspectives

Authors Iannetta M, Zingaropoli MA, D'Abramo A, Oliva A, Mastroianni CM, Vullo V, Ciardi MR

Received 7 March 2016

Accepted for publication 2 June 2016

Published 8 August 2016 Volume 2016:7 Pages 43—52


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 3

Editor who approved publication: Dr Stephen Ferrando

Marco Iannetta, Maria Antonella Zingaropoli, Alessandra D’Abramo, Alessandra Oliva, Claudio Maria Mastroianni, Vincenzo Vullo, Maria Rosa Ciardi

Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy

Abstract: 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.

Keywords: PML, JCV, NeuroAIDS, IRIS, diagnosis, therapy

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