{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T04:59:40Z","timestamp":1773809980160,"version":"3.50.1"},"reference-count":41,"publisher":"Georg Thieme Verlag KG","issue":"10","license":[{"start":{"date-parts":[[2023,10,29]],"date-time":"2023-10-29T00:00:00Z","timestamp":1698537600000},"content-version":"vor","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Progressive 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.<\/jats:p><jats:p>\n          Objective\u2003To describe the prevalence of PML-IRIS among PLWHA with PML and its main features in a tertiary hospital in Brazil.<\/jats:p><jats:p>\n          Methods\u2003We performed a retrospective cohort study. We included PLWHA with PML-IRIS patients admitted at Instituto de Infectologia Em\u00edlio Ribas, S\u00e3o Paulo, Brazil, between 2011 and 2021. We retrieved information on neurological manifestations, neuroimaging findings, treatments, and outcomes.<\/jats:p><jats:p>\n          Results\u2003We 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\u201350) 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\u201370) 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.<\/jats:p><jats:p>\n          Conclusion\u2003The 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.<\/jats:p>","DOI":"10.1055\/s-0043-1772831","type":"journal-article","created":{"date-parts":[[2023,10,29]],"date-time":"2023-10-29T23:37:35Z","timestamp":1698622655000},"page":"883-890","source":"Crossref","is-referenced-by-count":3,"title":["Acquired immunodeficiency syndrome-related progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome: prevalence, main characteristics, and outcomes in a Brazilian center"],"prefix":"10.1055","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7035-583X","authenticated-orcid":false,"given":"Monize Nascimento","family":"Santana","sequence":"additional","affiliation":[{"name":"Instituto de Infectologia Em\u00edlio Ribas, Departamento de Infectologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3888-9288","authenticated-orcid":false,"given":"Raphaela","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Instituto de Infectologia Em\u00edlio Ribas, Departamento de Infectologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3957-0284","authenticated-orcid":false,"given":"Arthur Cassa","family":"Macedo","sequence":"additional","affiliation":[{"name":"McGill University, Department of Neurology and Neurosurgery, Montreal QC, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8396-0263","authenticated-orcid":false,"given":"Rosa Maria Nascimento","family":"Marcusso","sequence":"additional","affiliation":[{"name":"Instituto de Infectologia Em\u00edlio Ribas, Departamento de Neurologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5451-9578","authenticated-orcid":false,"given":"Ruan de Andrade","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Instituto de Infectologia Em\u00edlio Ribas, Departamento de Infectologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7830-8716","authenticated-orcid":false,"given":"Jos\u00e9 Ernesto","family":"Vidal","sequence":"additional","affiliation":[{"name":"Instituto de Infectologia Em\u00edlio Ribas, Departamento de Neurologia, S\u00e3o Paulo SP, Brazil."},{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Departamento de Mol\u00e9stias Infecciosas e Parasit\u00e1rias, S\u00e3o Paulo SP, Brazil."},{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Laborat\u00f3rio de Investiga\u00e7\u00e3o M\u00e9dica (LIM 49), S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,10,29]]},"reference":[{"issue":"S 02","key":"ref1","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.3949\/ccjm.78.s2.02","article-title":"History and current concepts in the pathogenesis of PML","volume":"78","author":"E O Major","year":"2011","journal-title":"Cleve Clin J Med"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1128\/CMR.05031-11","article-title":"Molecular biology, epidemiology, and pathogenesis of progressive multifocal leukoencephalopathy, the JC virus-induced demyelinating disease of the human brain","volume":"25","author":"M W Ferenczy","year":"2012","journal-title":"Clin Microbiol Rev"},{"issue":"01","key":"ref3","first-page":"93","article-title":"Progressive multifocal leuko-encephalopathy; a hitherto unrecognized complication of chronic lymphatic leukaemia and Hodgkin's disease","volume":"81","author":"K E \u00c5str\u00f6m","year":"1958","journal-title":"Brain"},{"issue":"7712","key":"ref4","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1016\/S0140-6736(71)91777-6","article-title":"Cultivation of papova-like virus from human brain with progressive multifocal leucoencephalopathy","volume":"1","author":"B L Padgett","year":"1971","journal-title":"Lancet"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/S0733-8619(18)31105-8","article-title":"Progressive multifocal leukoencephalopathy","volume":"2","author":"B R Brooks","year":"1984","journal-title":"Neurol Clin"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/S1474-4422(10)70040-5","article-title":"Progressive multifocal leukoencephalopathy and other disorders caused by JC virus: clinical features and pathogenesis","volume":"9","author":"C S Tan","year":"2010","journal-title":"Lancet 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limited settings","volume":"416","author":"A Navis","year":"2020","journal-title":"J Neurol Sci"},{"issue":"02","key":"ref31","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S1413-8670(12)70297-0","article-title":"JC virus-associated central nervous system diseases in HIV-infected patients in Brazil: clinical presentations, associated factors with mortality and outcome","volume":"16","author":"F Piza","year":"2012","journal-title":"Braz J Infect Dis"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.jns.2017.09.002","article-title":"Post-cART progressive multifocal leukoencephalopathy era in a Brazilian center","volume":"381","author":"M A Lima","year":"2017","journal-title":"J Neurol Sci"},{"issue":"08","key":"ref33","doi-asserted-by":"crossref","first-page":"4175","DOI":"10.1128\/JCM.43.8.4175-4177.2005","article-title":"Reduced rate of diagnostic positive detection of JC virus DNA in cerebrospinal fluid in cases of suspected progressive multifocal leukoencephalopathy in the era of potent antiretroviral therapy","volume":"43","author":"A Marzocchetti","year":"2005","journal-title":"J Clin Microbiol"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/B978-0-444-63849-6.00013-X","article-title":"CNS immune reconstitution inflammatory syndrome","volume":"152","author":"L Bowen","year":"2018","journal-title":"Handb Clin Neurol"},{"issue":"S 01","key":"ref35","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1080\/13550280390195315","article-title":"Inflammatory reaction in progressive multifocal leukoencephalopathy: harmful or beneficial?","volume":"9","author":"R A Du Pasquier","year":"2003","journal-title":"J Neurovirol"},{"issue":"17","key":"ref36","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1212\/01.wnl.0000343735.44983.5e","article-title":"Steroids for PML-IRIS: a double-edged sword?","volume":"72","author":"J R Berger","year":"2009","journal-title":"Neurology"},{"issue":"14","key":"ref37","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1097\/00002030-199910010-00010","article-title":"Survival improvement of AIDS-related progressive multifocal leukoencephalopathy in the era of protease inhibitors","volume":"13","author":"J M Tassie","year":"1999","journal-title":"AIDS"},{"issue":"04","key":"ref38","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1111\/j.1468-1293.2008.00554.x","article-title":"Causes of the first AIDS-defining illness and subsequent survival before and after the advent of combined antiretroviral therapy","volume":"9","author":"S Grabar","year":"2008","journal-title":"HIV Med"},{"issue":"10","key":"ref39","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1086\/598335","article-title":"Incidence and outcome of progressive multifocal leukoencephalopathy over 20 years of the Swiss HIV Cohort Study","volume":"48","author":"N 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