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.

在HIV患者中，HCV合并感染与进行性多灶性白质脑病（PML）的风险增加有关。此外，在肝硬化患者中，无论是否与HCV感染有关，均已描述了PML。我们在这里描述了一个HIV / HCV合并感染的肝硬化患者，尽管受到HIV抑制并且CD4细胞计数超过250 / mm ³持续了2年，但仍发展为PML 。在PML发作时和HCV治疗之前进行的免疫学研究显示，幼稚的CD4细胞（CD45RA + CCR7 ⁺ CD27 ⁺ CD4 ⁺ T细胞-23％细胞，即75 / mm ³）减少，NK淋巴细胞减少，NK细胞异常并被激活（ CD3 ^- CD16 ⁺和/或CD56 ⁺）（5％淋巴细胞，即58 / mm ³，CD69 91％，NKp30 26％）。这种免疫力降低，可能与HIV感染，HCV感染或肝硬化，或二者结合，可能导致了PML的发展。