CLINICAL SCIENCEProgressive multifocal leukoencephalopathy in patients with immunovirological control and at least 6 months of combination antiretroviral therapyDalla-Pozza, Paula; Hentzien, Maximea; Allavena, Clotildeb; Doe de Maindreville, Annec; Bouiller, Kévind; Valantin, Marc-Antoinee; Lafont, Emmanuelf; Zaegel-Faucher, Oliviag; Cheret, Antoineh; Martin-Blondel, Guillaumei; Cotte, Laurentj; Bani-Sadr, Firouzéa,k Author Information aDepartment of Internal Medicine, Clinical Immunology and Infectious Diseases, Robert Debré Hospital, University Hospital of Reims bDepartment of Infectious Diseases, University Hospital of Nantes, Nantes cDepartment of Neurology, University Hospital of Reims dDepartment of Infectious Diseases, University Hospital of Besancon eDepartment of Infectious Diseases, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris fDepartment of Infectious Diseases, Necker Hospital, Assistance Publique des Hôpitaux de Paris, Paris gDepartment of Immunology and Hematology, Sainte-Marguerite Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille hDepartment of Internal Medicine, Kremlin Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Bicêtre iDepartment of Infectious Diseases, University Hospital of Toulouse, Toulouse, France and Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Toulouse jDepartment of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, and INSERM U1052, Lyon kUniversity of Reims Champagne-Ardenne, EA-4684/SFR CAP-SANTE, Reims, F-51095, France. Correspondence to Professor Firouzé Bani-Sadr, Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, CHU Robert Debré, Avenue du Général Koenig, 51092 Reims, France. Tel: +33 3 26 78 71 89; fax: +33 3 26 78 40 90; e-mail: [email protected] Received 3 September, 2021 Revised 12 November, 2021 Accepted 30 November, 2021 AIDS: March 15, 2022 - Volume 36 - Issue 4 - p 539-549 doi: 10.1097/QAD.0000000000003145 Buy Metrics Abstract Objectives and methods : Progressive multifocal leukoencephalopathy (PML) has rarely been reported in people with HIV (PWH) with long-term HIV immune-virological control. We describe the clinical and biological characteristics of patients with confirmed PML among PWH with a CD4+ cell count more than 200 cells/μl and an undetectable HIV RNA viral load after at least 6 months of combined antiretroviral therapy (cART) at the time of PML diagnosis, in the large French multicenter Dat’AIDS cohort. Results : Among 571 diagnoses of PML reported in the Dat’AIDS cohort between 2000 and 2019, 10 cases (1.75%) occurred in PWH with a CD4+ cell count greater than 200 cells/μl and an undetectable HIV RNA viral load after at least 6 months of cART. Median CD4+ cell count at PML diagnosis was 395 cells/μl (IQR 310–477). The median duration between the last detectable HIV viral load and the PML diagnosis was 41.1 months (IQR 8.2–67.4). Only one patient treated with rituximab-based chemotherapy for a large B-cell lymphoma had an established risk factor for PML. Among the nine other patients with no apparent severe immunodeficiency, multiple factors of impaired immunity could have led to the development of PML: hepatitis C virus (HCV) co-infection (n = 6), cirrhosis (n = 4), HHV-8 co-infection (n = 3) with Kaposi's sarcoma (n = 2) in association with Castleman's disease (n = 1) and indolent IgA multiple myeloma (n = 1). Conclusion : This study highlights that factors other than low CD4+ cell count and high HIV viral load may be associated with the occurrence of PML. Further studies are warranted to investigate in greater detail the immunologic characteristics of PWH with immune-virological control who develop PML. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.