Sep 23, 2001
I have been diagnosed with suspected pml, in the very early stages and am being treated with cidifor and sustiva, zerit, epiver. I seem to be improving with time and my doctor says I might be able to drive and go back to work, but would first like to see an improvement with my Cd4 count which is 60. How true is this and should i try IL2 also. Many thanks. PS I have just also been told that I am now undectectable.
Response from Dr. Aberg
The best therapy for PML is antiretroviral therapy which you are on. You do not say how long you have been on therapy but the fact that your viral load is undetectable is great news. Hopefully your CD4+ T-cell count will continue to go up.
Progressive Multifocal Leukoencephalopathy is caused by a virus called JC. There have been small reports of patients having improvement with either intrathecal (injected directly into the central nervous system) cytosine arabinoside ( a type of chemotherapy) or cidofovir (an anti-viral used to treat cytomegalovirus). Unfortunately, larger controlled studies of each of these drugs failed to show any significant benefit. We really do not have any known successful treatments for PML except for antiretroviral therapy.
Interleukin-2 has been used in individuals whose CD4 counts do not rise despite having an undetectable HIV viral load. Again, there is no convincing evidence that this is helpful in the setting of PML. I would caution the use of IL-2 for you except in the setting of a clinical trial. There is insufficient data on the use of IL-2 in patients who have acute opportunistic infections. I would encourage you to see if there is a neurologist who participates in the Neurologic AIDS Research Consortium. There may be clinical trials of interest to you.
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