Remission of progressive multifocal leucoencephalopathy after antiretroviral therapy

Abstract

Elliot and colleagues1Elliot B Aromin I Gold R Flanigan T Mileno M 25 year remission of AIDS-associated progressive multifocal leukoencephalopathy with combined antiretroviral therapy.Lancet. 1997; 349: 850Summary Full Text Full Text PDF PubMed Scopus (52) Google Scholar add further evidence to reports of a favourable treatment outcome of progressive multifocal leucoencephalopathy (PML) to antiretroviral therapy. We have seen a prophylactic effect of antiretroviral therapy for this disorder. We conducted a retrospective analysis of all cases of neurological disease at our local centre between 1991 and 1994, which included 1109 individuals with AIDS. Our aim was to assess the risk of HIV-related dementia and opportunistic brain disease (PML, cerebral toxoplasmosis, and primary central-nervous-system lymphoma) among patients with AIDS in relation to use of licensed antiretroviral drugs. Together with an expected reduction in the risk of HIV-related dementia, we also found that patients treated with zidovudine for up to 18 months had a lower risk of opportunistic brain disease than patients who had not used antiretrovirals.2Baldeweg T, Catalan J, Gazzard BG. Risk of brain disease in AIDS and antiretroviral treatment. Paper presented at the Third Annual Meeting British HIV Association (BHIVA), Warwick, April 11–13, 1997, UK.Google Scholar In particular, zidovudine-treated patients had a reduced risk of PML (relative risk 0·23 [95% CI 0·06–0·90]). It will be important to establish whether new combination therapies require similar penetration of the central nervous system as found with zidovudine to achieve neuroprophylactic efficacy.