Steroids for PML-IRIS

The immune reconstitution inflammatory syndrome (IRIS) is observed with a broad spectrum of HIV-related opportunistic infectious diseases and autoimmune disorders.1 Its occurrence with progressive multifocal leukoencephalopathy (PML) is not unanticipated. In this issue of Neurology ®, Tan et al.2 provide an excellent retrospective analysis of PML-IRIS occurring following the institution of antiretroviral therapy (ART) for HIV infection. Fifty-four patients are included in the analysis; all but four were extracted from a survey of the literature. The authors address the clinical features, virology, neuroradiology, pathology, and outcomes of PML-IRIS and comment on the potential role of corticosteroid therapy. They suggest that corticosteroids, especially if administered early and for a prolonged period of time, may improve survival. However, only 12 (22%) of the 54 patients received corticosteroids and the analysis comparing this group to those who had not received steroids revealed no statistically significant difference in overall duration of survival, percentage of survivors, time to death, or mortality. The role of corticosteroid therapy for PML-IRIS should be analyzed with foreknowledge of the critical contribution …