indinavir-sulfate and Leukoencephalopathy--Progressive-Multifocal

Topics: Acquired Immunodeficiency Syndrome; Adult; Antiretroviral Therapy, Highly Active; Antiviral Agents; Brain; CD4 Lymphocyte Count; Cidofovir; Cytosine; Dideoxynucleosides; Encephalitis; False Negative Reactions; Fatal Outcome; Humans; Immunocompromised Host; Indinavir; JC Virus; Lamivudine; Leukoencephalopathy, Progressive Multifocal; Magnetic Resonance Imaging; Male; Organophosphonates; Substance Abuse, Intravenous; Time Factors; Virus Activation; Zidovudine

We reported a patient with acquired immunodeficiency syndrome (AIDS)-associated progressive multifocal leukoencephalopathy (AIDS-PML), whose condition improved after highly active anti-retroviral therapy (HAART). A 70-year-old man was admitted to our hospital because of worsening left hemiplegia and disturbance of consciousness. During the past 30 years, he frequently traveled to the United States and southeast Asia. On neurological examination, he was somnolent and left hemiplegia with severe rigospasticity was present. The deep tendon reflexes showed hyper-reflexes with extensor plantar responses. Laboratory studies showed pancytopenia and positive HIV-1 antibodies. The CD4 cell count was 38/mm3 and his HIV viral RNA load in the blood was 9,500 copies/ml. T2-weighted magnetic resonance imaging (MRI) of the brain revealed asymmetrical high intensity white matter lesions in the right fronto-parietal, and left frontal regions and in the cerebellar hemisphere. The cerebrospinal fluid (CSF) protein elevated to 91 mg/dl with a normal cell count. The diagnosis of PML was confirmed by the detection of JC virus DNA in the CSF using a nested polymerase chain reaction assay. Three weeks after starting HAART with zidovudine, lamivudine, and indinavir, he was able to respond to simple commands. Two months later, the HIV viral RNA load decreased to less than 400 copies/mm3, and no JC virus DNA was detected in the CSF, with an increase of the CD4 cell count to 285/mm3 in the blood. A follow-up MRI of the brain showed a reduction in the cerebellar and cerebral white matter lesions. The recovering immune function by decreasing of the HIV load after HAART might suppress JC virus replication. It was suggested that HAART would become a beneficial treatment for patients with AIDS-PML.

Topics: Acquired Immunodeficiency Syndrome; Aged; Antiretroviral Therapy, Highly Active; Humans; Indinavir; JC Virus; Lamivudine; Leukoencephalopathy, Progressive Multifocal; Male; Treatment Outcome; Zidovudine

Topics: Acquired Immunodeficiency Syndrome; Adult; Antiviral Agents; Didanosine; Drug Therapy, Combination; Humans; Indinavir; Leukoencephalopathy, Progressive Multifocal; Male

Topics: Adult; Anti-HIV Agents; CD4 Lymphocyte Count; Drug Therapy, Combination; HIV Seropositivity; Humans; Indinavir; Lamivudine; Leukoencephalopathy, Progressive Multifocal; Male; Viral Load; Zidovudine

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-HIV Agents; CD4 Lymphocyte Count; Didanosine; Drug Therapy, Combination; HIV Protease Inhibitors; Humans; Indinavir; Leukoencephalopathy, Progressive Multifocal; Male; Time Factors; Zidovudine

Topics: Aged; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Ataxia; Follow-Up Studies; Hemiplegia; Humans; Indinavir; Lamivudine; Leukoencephalopathy, Progressive Multifocal; Male; Remission Induction; Stavudine