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my lover and pml
Nov 21, 2006

My lover has a t'cell count of 10 and a viral load of 300,000 per mil.His M.R.I came back about a month ago and his I.D doctor thinks that it is P.M.L he is very sick now and is in the hospital,hospice came to talk to me 11/17/2006,but the doc also told me that when hospice comes in he cant take his aids meds and I also have been doing some reasearch on antipsychotic drugs and pml do you know if they work or not or what drugs should I ask his doctor about to help him live.He is only 24 and something so bad should not be happening.Any info you can give me will help today I asked his doctor about azt meds that help pml 1200 to 1500 mg's of azt meds he told me that he was thinking about that and switched him to combivir do you think this will help.Thanks

Response from Dr. Pierone

Sorry to hear about you lover's situation. PML stands for progressive multifocal leukoencephalopathy, a brain infection caused by polyomavirus JC. The treatment of PML is based on HAART for HIV. Bringing HIV replication under control and restoring immune function usually translates into control of PML. Unfortunately, if there is a favorable response to HAART, there is often only partial neurological recovery.

Adding to the complexity of this problem is that some patients develop PML shortly after starting HAART and are found to have inflammatory PML. This condition likely represents a form of immune reconstitution syndrome and there may be a role for corticosteroids in this situation, although we have no studies as yet.

If someone is already on HAART and develops PML in the context of treatment failure and multi-drug resistant virus, then the prognosis is guarded. Successful response in this scenario would depend on the availability of medications (sometimes investigational) to bring HIV replication under control.

The use of AZT for PML is based on old studies from the pre-HAART era and probably not important. The key is to rapidly restore immune function and hope for recovery. In the case of inflammatory PML it would not be unreasonable to add corticosteroids as well, especially in the case of neurological worsening or significant inflammation on MRI scan.

In some cases of PML with extensive brain involvement (especially if it progresses despite therapy) hospice care is a reasonable option. I hope that this information helps and I hope things turn out well.



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