AEGiS-11IAC: Prolonged remission of AIDS-associated Progressive Multifocal Leukoencephalopathy with combined antiretroviral therapy.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

Prolonged remission of AIDS-associated Progressive Multifocal Leukoencephalopathy with combined antiretroviral therapy.

Int Conf AIDS 1996 Jul 7-12; 11:222 (abstract no. Th.B.183)
Elliot BC, Aromin I, Flanigan TP, Mileno M; The Immunology Center, Miriam Hospital, Providence, RI. Fax: (401) 751-2398.

OBJECTIVE: Progressive Multifocal Leukoencephalopathy, a disease which causes demyelination of the white matter of the brain, is currently untreatable in patients with AIDS and quickly progresses to death.

METHODS: A 35 year-old male diagnosed with AIDS-associated PML by MRI presented with marked expressive aphasia and extensive right-sided weakness. He received AZT 200 mg t.i.d. and ddI 200 mg b.i.d. for 24 weeks as part of a controlled trial. At 24 weeks, Indinavir, a protease inhibitor, was added to the regimen, 600mg every 6 hours. The patient was monitored with physical exam, CD4 counts, and viral load measurements for 52 weeks.

RESULTS: CD4 count at baseline was 30 cells/mm3, at Week 24 80 cells/mm3, and at Week 52 230 cells/mm3. Viral load at baseline was 189,900 copies/mL, at Week 24 14,400 copies/mL, and at Week 44,240 copies/mL. By Week 4 of the trial, dramatic improvement was noted in the patient's hemiparesis and rapidity and clarity of speech. By Week 12, the patient was able to work as a fisherman and take part in a strenuous exercise regimen which included weight lifting. A repeat MRI, at Week 59, showed a dramatic decrease in the PML lesions.

CONCLUSIONS: We report prolonged remission of PML with combined antiretroviral therapy which included a protease inhibitor. Clinical resolution and radiographic improvement was associated with a dramatic rise in CD4 count and a decrease in viral load. Therefore, more effective antiretroviral regimens may lead to clinical remissions in persons with PML.

Keywords: AEGIS, Leukoencephalopathy, Progressive Multifocal, Acquired Immunodeficiency Syndrome, CD4 Lymphocyte Count, Zidovudine, Viral Load, Anti-HIV Agents, Indinavir, Didanosine, Brain, Magnetic Resonance Imaging, Male, Human, ICA11

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ThB183