Treatment of AIDS-associated progressive multifocal leukoencephalopathy with highly active antiretroviral therapy

lytic cycle. Objectives: To evaluate the efficacy of highly active antiretr oviral therapy (HAART) in 12 patients with AIDS-associated progressive mult ifocal leukoencephalopathy (PML). Patients and methods: The diagnosis of PML was established by brain biopsy in six patients and by neuroimaging findings and PCR detection of JC virus in cerebrospinal fluid (CSF) in six patients. We also studied 13 consecutiv e AIDS patients with biopsy-proven PML cared for in the same institution be fore HAART was available. Eleven patients of the HAART group and eight pati ents of the control group received intravenous arabinoside cytosine cycles. Results: With HAART, the median decrease in the HIV viral load was 3.58 log (10) copies/ml and the median increase in the CD4 cell count was 74 x 10(6) /l. The median survival time after PML diagnosis was 545 days in the HAART group and 60 days in the control group (P < 0.001, log-rank test). In the H AART group, the neurological deficits improved substantially in six patient s and stabilized in six patients. Eleven patients underwent follow-up crani al computed tomography or magnetic resonance scan that showed improvement o f PML lesions in 10 patients and stabilization in one patient. Follow-up CS F analysis showed clearance of JC virus in six out of seven patients who ha d an initial positive result. Conclusions: This study shows that HAART may increase the survival, clinica l status and radiological features of AIDS patients with PML. Clearance of JC virus from CSF has been found, suggesting that immune reconstitution can interrupt the IC virus (C) 1998 Lippincott Williams & Wilkins.