Basic information of patients:
From Oct 2017 to Jan 2019, a total of 10 cases were diagnosed of PML, including eight males (80%) and two females (20%). These patients were at their middle age (38.7±8.2 years) with advanced immunodeficiency (CD4 T cell count 46 (2-241) cells/ml). HIV RNA was detectable in the majority patients (80%). The value of HIV RNA was ranged from less than 40 to 2.81 *105 copies/ml, with a median of 5.99 *104 copies/ml.
HIV infection was not diagnosed until onset of PML symptoms in four patients. Two patients never received ART although HIV infection has been diagnosed for 6 and 8 years, respectively. Two patients who had resistance to current ART regimens developed symptoms after ART for 6 months and 12 years, with HIV viral load of 1.3 *105 copies/ml and 2.3 *104 copies/ml, respectively. One patient developed symptoms after 1 month of ART. Two cases were complicated with pulmonary non-tuberculosis Mycobacterium infection, and no other co-infection was found in all the patients.
Symptom, imaging and CSF examination
The onset of the disease is occult, gradually aggravated. The time from symptoms onset to admission was 0.5-3 months. Dyskinesia (40%), convulsions (30%), dizziness (30%), cognitive impairment (20%) and speech impairment (10%) were the most common symptom. Symptoms in case 9 were related to immune reconstruction syndrome after antiviral therapy. (See Table 1)
Lesions were found in various parts of the brain in MRI examination. The lesions were located under the tentorium cerebellum in 3 cases (30%) and above the tentorium cerebellum in the rest (70%) (see Figure 1) . For CSF test, levels of white blood cell, glucose and chloride were normal while slight increase of protein was observed in four patients (40%).
JCV sequence in the cerebrospinal fluid varied from 3-12531 reads, median 67 reads (see Table 2).
All patients received ART. Four of them started antiretroviral treatment immediately, 4 had been already treated for 1-3 months, 2 adjusted regimen according to drug resistance reports. Either raltegravir or dolutegravir was included in the regimen for every patient. Three patients received quadruple regimen to strengthen antiviral therapy. Supportive treatment were also given to alleviate symptoms.
Two patients died at 2 and 5 months after onset of symptoms respectively. The remaining 8 cases survived and were followed-up for 2-18 months. Two patients had survived for more than one year. Symptoms in five of the patients were relieved, but did not improve in the other three patients.