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Issue No. 15 | July 14, 2017

News and Features

Updates to the PML/JC Virus Infection Section of the Adult and Adolescent Opportunistic Infections Guidelines

The progressive multifocal leukoencephalopathy (PML)/JC virus infection section of the Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents was recently updated. The following is a summary of what’s changed in this revision:

  • Evolving work on clinical PML management has allowed some clarification about the value and use of CSF PCR DNA detection, emphasizing the use of highly sensitive assays that are required to optimize sensitivity of CSF testing for JC virus and its specificity to the setting of PML. Also of interest is work demonstrating increases in JC-specific IgG with the onset of PML, recognizing that mere detection of JC antibodies is not generally helpful because of the high prevalence of JC antibodies in the population. A subtle but important evolution of understanding of PML management is that immune reconstitution inflammatory syndrome (IRIS) is common, and when severe may be life-threatening in itself, leading to recommendation of corticosteroid use when it is suspected to be driving post-immune reconstitution clinical deterioration. Many references were also updated in this revision to reflect the most recent reports about PML detection and treatment.

Recent News from NIH: