Abstract
In HIV patients, HCV co-infection has been associated with an increased risk of progressive multifocal leukoencephalopathy (PML). Furthermore, PML has also been described in patients with cirrhosis, whether related to HCV infection or not. We describe here the case of a HIV/HCV co-infected patient with cirrhosis who developed PML despite HIV suppression and CD4 cell count above 250/mm3 for 2 years. Immunological studies performed at onset of PML and before HCV therapy showed a decrease in naïve CD4 cells (CD45RA+CCR7+CD27+ CD4+ T cells - 23% cells, i.e. 75/mm3) and NK lymphopenia with abnormal and activated NK cells (CD3- CD16+ and/or CD56+) (5% lymphocytes, i.e. 58/mm3, CD69 91%, NKp30 26%). This impaired immunity, possibly related to HIV infection, or HCV infection or cirrhosis, or a combination thereof, could have led to the development of PML.
Keywords:
Cirrhosis; HCV infection; HIV infection; HIV-HCV co-infection; Natural killer immunity; Progressive multifocal leukoencephalopathy.
MeSH terms
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Anti-HIV Agents / therapeutic use*
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Antiretroviral Therapy, Highly Active
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CD4 Lymphocyte Count
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CD4-Positive T-Lymphocytes / immunology
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CD4-Positive T-Lymphocytes / pathology
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CD4-Positive T-Lymphocytes / virology
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Coinfection
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HIV / drug effects
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HIV / immunology
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HIV / pathogenicity
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HIV Infections / diagnostic imaging
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HIV Infections / drug therapy
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HIV Infections / immunology*
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HIV Infections / virology
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Hepacivirus / immunology
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Hepacivirus / pathogenicity
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Hepatitis C, Chronic / diagnostic imaging
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Hepatitis C, Chronic / drug therapy
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Hepatitis C, Chronic / immunology*
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Hepatitis C, Chronic / virology
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Humans
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JC Virus / immunology
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JC Virus / pathogenicity
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Killer Cells, Natural / immunology
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Killer Cells, Natural / pathology
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Killer Cells, Natural / virology
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Leukoencephalopathy, Progressive Multifocal / diagnostic imaging
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Leukoencephalopathy, Progressive Multifocal / drug therapy
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Leukoencephalopathy, Progressive Multifocal / immunology*
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Leukoencephalopathy, Progressive Multifocal / virology
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Liver Cirrhosis / diagnostic imaging
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Liver Cirrhosis / drug therapy
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Liver Cirrhosis / immunology*
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Liver Cirrhosis / virology
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Lymphopenia / diagnostic imaging
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Lymphopenia / drug therapy
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Lymphopenia / immunology*
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Lymphopenia / virology
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Magnetic Resonance Imaging
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Male
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Middle Aged