Convection-enhanced intraparenchymal delivery (CEID) of cytosine arabinoside (AraC) for the treatment of HIV-related progressive multifocal leukoencephalopathy (PML)

AIDS-related PML continues to be a relatively common and rapidly fatal infe ction in patients with AIDS, and no effective therapy has been established to alleviate the effects of this disease. Through the years, isolated repor ts and small case studies have shown somewhat encouraging results using cyt osine arabinoside (AraC) in the treatment of PML. The optimism behind the u se AraC for this disease began to fade with ACTG trial 243, which suggested that AraC had no benefit in patients with HIV-related PML. In this article , we provide evidence that suggests that the failure of AraC in the ACTG tr ial may have been due to insufficient delivery of the drug through traditio nal intravenous and intrathecal routes. Furthermore, we provide evidence th at convection-enhanced intraparenchymal delivery of AraC may prove to be a safe and effective means of treating this infection, and we outline a clini cal trial that we have recently undertaken to test this hypothesis.