Exploring the effectiveness of cytarabine in people living with HIV with progressive multifocal leukoencephalopathy: a retrospective cohort study in Chongqing, China

IF 2.5 4区医学 Q3 IMMUNOLOGY

Journal of neuroimmunology Pub Date : 2025-06-21 DOI:10.1016/j.jneuroim.2025.578676

Min Liu , Huan Li , Mei Li, Qin Zeng, Hong-Hong Yang

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引用次数: 0

Abstract

Background

The incidence of progressive multifocal leukoencephalopathy (PML) in people living with HIV (PLWH) is approximately 2 %–4 % globally, and there is currently no effective therapeutic strategy. Cytarabine has been reported to increase the survival probability of PLWH with PML; however, its effectiveness remains controversial. The present study aimed to explore whether cytarabine improves the outcomes of PLWH with PML.

Methods

We retrospectively collected data from PLWH who were admitted to the hospital and were diagnosed with PML from January 1, 2019, to October 31, 2023, in Chongqing, China, and then stratified the patients into two groups according to whether they did or did not receive cytarabine treatment. The clinical outcomes and mortality rates were assessed.

Results

A total of 41 patients were included in our study. The median age at the time of hospital admission was 44 years [interquartile range (IQR), 36–51]. The patient cohort had a median CD4+ T-cell count of 68.0 (38.5–109.5) cells/mL and a median HIV viral load of 5.05 (2.53, 5.76) log10 copies/ml. 15 patients received intravenous cytarabine and antiretroviral therapy (ART), and 26 patients did not receive cytarabine (24 patients received ART, and 2 patients did not receive ART). In the cytarabine group, 7 patients (46.7 %) died, 4 patients (26.7 %) improved, 2 patients (13.3 %) stabilized, and 2 patients (13.3 %) worsened. In the noncytarabine group, 15 (57.7 %) patients died, 7 patients (26.9 %) improved, 3 patients (11.5 %) stabilized, and 1 patient (3.9 %) worsened; the clinical outcomes did not significantly differ between the two groups (P > 0.05). The overall mortality rate and 30-day, 90-day, 180-day and one-year mortality rates were lower in the cytarabine group than in the noncytarabine group, but the differences were not significant (P > 0.05).

Conclusions

Our results suggest that treatment with cytarabine seems to fail to improve the survival rates of PLWH with PML. Our study is small and cannot definitively rule out cytarabine activity against PML. Future studies in a larger cohort and longer observations are needed.

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探讨阿糖胞苷治疗进行性多灶性白质脑病的有效性：中国重庆的一项回顾性队列研究

全球HIV感染者（PLWH）进行性多灶性脑白质病（PML）的发病率约为2% - 4%，目前尚无有效的治疗策略。有报道称阿糖胞苷可提高PLWH合并PML的生存率；然而，其有效性仍然存在争议。本研究旨在探讨阿糖胞苷是否能改善PLWH合并PML的预后。方法回顾性收集2019年1月1日至2023年10月31日在中国重庆住院并诊断为PML的PLWH的数据，然后根据是否接受阿糖胞苷治疗将患者分为两组。评估临床结果和死亡率。结果共纳入41例患者。入院时的中位年龄为44岁[四分位间距（IQR）， 36-51]。患者队列的中位CD4+ t细胞计数为68.0（38.5-109.5）个/mL，中位HIV病毒载量为5.05 (2.53,5.76)log10拷贝/mL。15例患者接受静脉注射阿糖胞苷和抗逆转录病毒治疗（ART）， 26例患者未接受阿糖胞苷治疗（24例接受ART治疗，2例未接受ART治疗）。阿糖胞苷组死亡7例（46.7%），好转4例（26.7%），稳定2例（13.3%），恶化2例（13.3%）。非阿糖胞苷组死亡15例（57.7%），好转7例（26.9%），稳定3例（11.5%），恶化1例（3.9%）；两组临床结果无显著差异(P >；0.05)。阿糖胞苷组的总死亡率以及30天、90天、180天和1年死亡率均低于非阿糖胞苷组，但差异不显著(P >；0.05)。结论阿糖胞苷治疗不能提高PLWH合并PML患者的生存率。我们的研究规模较小，不能明确排除阿糖胞苷对PML的活性。未来的研究需要更大的队列和更长时间的观察。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of neuroimmunology 医学-免疫学

CiteScore

6.10

自引率

3.00%

发文量

154

审稿时长

37 days

期刊介绍： The Journal of Neuroimmunology affords a forum for the publication of works applying immunologic methodology to the furtherance of the neurological sciences. Studies on all branches of the neurosciences, particularly fundamental and applied neurobiology, neurology, neuropathology, neurochemistry, neurovirology, neuroendocrinology, neuromuscular research, neuropharmacology and psychology, which involve either immunologic methodology (e.g. immunocytochemistry) or fundamental immunology (e.g. antibody and lymphocyte assays), are considered for publication.