Important note: Information in this article was accurate in 2002. The state of the art may have changed since the publication date. A friend who has been diagnosed with PML (Progressive multifocal leucoencepha). What drugs are available to him? What are his chances for survival?
Daniel H. Bowers, M. D.
Pacific Oaks Medical Group
Unfortunately, PML (please see: http://www.aegis.org/pubs/nmap/1999/513-pml.html) has no clearly successful treatment. The current "standard" treatment is with Ara-C, also known as cytosine arabinoside. However, this drug has shown to be marginally and/or inconsistently successful. It is also fairly toxic, causing nausea, fevers, and bone marrow toxicity. It is most commonly given into the cerebrospinal fluid either through spinal taps or via a shunt which is placed into the brain.
The most important part of treatment is to be sure the patient is on a potent, multiple drug antiretroviral regimen which includes drugs that cross well into the brain. AZT in high doses (1200 mg/day) is considered by many to be the best. Others include 3TC, ddI, d4T, ddC, nevirapine, and amprenavir. It is important that the regimen contains a protease inhibitor to maximize penetration into the sanctuary sites where HIV may be sequestered.
Cidofovir, an anti-CMV drug, is being studied, mainly in Europe. There is some early hint that it may be somewhat helpful.
Beyond looking at studies of groups of patients, it is important to look at individuals. There are numerous reports of individual patients responding quite well, far exceeding the usual poor prognosis of survival in terms of "months only". Often the decision if and/or how to treat is very personal - being based on quality of life issues, other co-existing debilitating health problems, emotional and physical tolerance to uncomfortable side effects, the will and/or reasons to fight on, etc.
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