{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:04:19Z","timestamp":1787061859424,"version":"build-2736575974"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Progressive multifocal leukoencephalopathy (PML) is a severe demyelinating disease caused by JC polyomavirus (JCV), affecting immunocompromised individuals. We describe PML demographic, clinical, radiological, and laboratory characteristics and survival over time and according to underlying condition in a large retrospective patient cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective cohort including Italian PML patients observed between 1987 and 2024, with known year of diagnosis and underlying disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 456 cases with either a definite (n = 376, 82.4%) or clinico-radiological (n = 80, 17.6%) PML diagnosis. The relative frequency of human immunodeficiency virus (HIV)-associated cases decreased through four time periods (1987\u20131996; 1997\u20132004; 2005\u20132012; 2013\u20132024) from 99% to 43%, in parallel with increasing age (P &amp;lt; .0001), proportion of women (P &amp;lt; .001) and CD4+ counts (P &amp;lt; .001) but not cerebrospinal fluid (CSF) or plasma JCV-DNA levels at diagnosis. One-year survival probability increased from 23.8% in 1987\u20131996 to 59.2% in 2013\u20132024, with highest values in natalizumab-treated multiple sclerosis (93.8%), followed by combination antiretroviral treatment (cART)-treated HIV infection (55%), hematological malignancies (50.8%), primary immunodeficiencies (41.3%), and cART-untreated HIV infection (11.9%). At multivariate analysis excluding cART-untreated people with HIV, JCV-DNA levels in both CSF and plasma were independently associated with an increased mortality risk of 2.9% and 7.2%, respectively, for each Log increase in JCV-DNA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This observational study showed a changing epidemiological context over 37 years. Although survival improved over time, it remained poor even in the last decade, with a one-year survival probability of 59.2%.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaf501","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T07:37:33Z","timestamp":1757403453000},"page":"607-617","source":"Crossref","is-referenced-by-count":4,"title":["Changing Clinical and Laboratory Characteristics of Progressive Multifocal Leukoencephalopathy: A Retrospective National Cohort Study"],"prefix":"10.1093","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8663-0588","authenticated-orcid":false,"given":"Ilaria","family":"Mainardi","sequence":"first","affiliation":[{"name":"Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute , Milan ,","place":["Italy"]},{"name":"Neurovirology Research Unit, IRCCS San Raffaele Scientific Institute , Milan 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