Dr. Feinberg,

I have written to you in the past about my brother that was diagnosed in Nov, 1999 with PML. You have been very helpful to me in the past and I am hoping you can answer a question for me. Each time my brother goes to the doctor's, he is getting good news. His tcells went from 10 to 273 and his viral load is 525. His last MRI showed that some of the lesions are getting smaller and that some have disappeared completely. My question to you is, if all of these positive changes are taking place, why is he still having such difficulty with everything? His coordination is still way off, his walking and speech have not improved much and his balance isn't much better either. Will he ever be able to do any more than what he is doing now?

I'm sorry to hear that your brother's clinical improvement hasn't kept pace with his virologic and immune system improvement, and this may be due to a number of factors. First of all, the brain is a pretty delicate organ and does not recover easily from injury. So it is possible that you may still see more improvement in your brother's overall condition than you have to date, but it may take a while. It is also possible that recovery of function is going to be limited-- but that is a situation where only time will tell. I don't have any crystal ball-gazing powers, and cannot hazard a guess about the extent of his ultimate recovery or how long it will take. But it is heartening that he is alive, and has had some improvement. A few years ago his lifespan would have been measured in months, and not very many of these either, and here he is, alive almost 2 years later. The MRI scan documents shrinkage of the lesions, which is only good. It may take more time to see additional benefit. Be patient and supportive. You must love your brother very much, and certainly he's lucky to have you as his sister. Hang in there!