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pml, hiv, hepB and C co-infections
Mar 28, 2009

My husband was diagnosed with hep B and C as well as Hiv over 20 years ago, as a teen. He tried AZT drugs briefly, but gave them up many years ago. Two years ago, he was diagnosed with PML as well as a Hiv infection in his brain. His count was 75 at that time. He began AZT treatment, and nearly died, however he has now progressed to a count of 375 and undetectable virus load. He had an MRI one year ago which showed that the PML was progressing, however his condition has not deteriorated. He has progressed from severe dementia and left side paralysis to NO paralysis, although with infrequent 5-10 minute episodes of left arm paralysis which completely fade. He is now having liver problems..ie pain, some nausea, weakness...facial swelling, and his salivary glands are quite swollen. His doctors will not address the question of how long he might have. We are aware that they don't know, but would like some reliable statistics at least? His hemophile nurse told us 2-3 years, as his liver would likely be unable to handle the drugs...he also takes 1300 mg valproate daily, and antidepressants as well as approximately 500mg Tylenol daily...any info would be great...thanks so much.

Response from Dr. McGovern

It is difficult to give much helpful information since your husband's care is quite complex and I don't know all the details. A few general comments I can make are related to hepatitis B. There are several medications for HIV that also have dual activity for hepatitis B. One of these is Truvada which combines tenofovir with emtricitabine. Both have dual activity. You may want to ask if he has known chronic hepatitis B infection (since patients are often just exposed in the past and have cleared infection).

As for the hepatitis C, I would not expect that they are going to want to give him interferon right now since this would also complicate his care and could increase confusion. It will be important to follow his recovery further for his PML.

I send your husband my best wishes. It sounds like he has made remarkable improvement in terms of his PML. His doctors may not be able to determine prognosis now because they themselves may be uncertain since he has responded to his HIV medications with great T cell improvement. Would try to discuss his prognosis further with his doctors.



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