JC virus-associated central nervous system diseases in HIV-infected patients in Brazil: clinical presentations, associated factors with mortality and outcome

introduction: several presentations of neurologic complications caused by jc virus (jcv) in human immunodeficiency virus (hiv)-infected patients have been described and need to be distinguished from the "classic" form of progressive multifocal leukoencephalopathy (pml). the objectives of this study were: 1) to describe the spectrum and frequency of presentations of jcv-associated central nervous system (cns) diseases; 2) identify factors associated with in-hospital mortality of patients with jcv-associated cns disease; and 3) to estimate the overall mortality of this population. material and methods: this was a retrospective study of hiv-infected patients admitted consecutively for jcvassociated cns diseases in a referral teaching center in s？o paulo, brazil, from 2002 to 2007. all patients with laboratory confirmed jcv-associated cns diseases were included using the following criteria: compatible clinical and radiological features associated with the presence of jcv dna in the cerebrospinal fluid. jcv-associated cns diseases were classified as follows: 1) classic pml; 2) inflammatory pml; and 3) jc virus granule cell neuronopathy (gcn). results: we included 47 cases. jcv-associated cns diseases were classified as follows: 1) classic pml: 42 (89%); 2) inflammatory pml: three (6%); and 3) jc virus gcn: four (9%). nosocomial pneumonia (p = 0.003), previous diagnosis of hiv infection (p = 0.03), and imaging showing cerebellar and/or brainstem involvement (p = 0.02) were associated with in-hospital mortality. overall mortality during hospitalization was 34%. conclusions: novel presentations of jcv-associated cns diseases were observed in our setting; nosocomial pneumonia, previous diagnosis of hiv infection, and cerebellar and/or brainstem involvement were associated with in-hospital mortality; and overall mortality was high.