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PML and Stable CD4 counts
Aug 1, 2013

I developed IRIS-PML five years ago. Understanding that PML and PML with seizures is very rare. How do I find the latest documentation regarding outcomes of patients diagnosed with PML and living well with HIV? After living with cognitive deficits for 5 years, I will be seeing a neurologist at Johns Hopkins.

Response from Dr. Henry

There is less information about PML these days due to lower rate due to effectiveness of current HIV drugs. The damage from PML I often view like a stroke in the setting of high blood pressure. The type of symptoms from a stroke depends on the size and location of the vascular damage. Recovery is variable. Controlling the blood pressure may prevent future strokes (akin to controlling HIV infection with meds) but the damaged brain recovery is highly variable with some brain damage not reversible even if the underlying condition is now well managed (blood pressure or HIV control). I care for some patients who developed PML in the mid 1990s and survived after starting effective HIV treatment (prior to that had a terrible course and prognosis). Those patients all experienced some improvement neurologically but have persistent significant impairment (again similar to what one might see in a stroke patient where some of the brain was damaged and did not heal well though therapy can improve some function in some cases). KH



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