Visual loss secondary to acquired immunodeficiency virus-related progressive multifocal leukoencephalopathy demonstrating clinical improvement with highly active antiretroviral therapy.
BACKGROUND
Progressive multifocal leukoencephalopathy (PML) is a demyelinating brain disease caused by the JC papovavirus. This disease afflicts the immunocompromised, particularly those infected with the human immunodeficiency virus (HIV). PML progresses rapidly, causing a variety of visual and neurologic complications.


METHODS
A 49-year-old HIV-positive man presented with reduced vision, a bilateral left hemianopsia, left-sided motor dysfunction, and mild dementia. Confirmation of the presence of the JC virus in the cerebrospinal fluid and characteristic computed tomography and magnetic resonance imaging changes led to the diagnosis of PML. No treatment was initiated other than continuation of highly active antiretroviral therapy (HAART). The patient was re-examined 8 months later and found to have significant resolution of his visual and neurological symptoms.


CONCLUSIONS
PML often results in devastating and deadly neurologic deterioration in HIV-positive patients. Although treatment options are limited, HAART can lead to clinical improvement of symptoms and prolong survival time.
Diller
Rebecca
R
Dayton Veterans Affairs Medical Center, Dayton, Ohio 45428, USA. Rebecca.Diller@med.va.gov
Thompson
Kelly
K
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D000225:Adenine / Q000031:analogs & derivatives; D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D048588:Benzoxazines; D002555:Cerebrospinal Fluid / Q000821:virology; D003521:Cyclopropanes; D004359:Drug Therapy, Combination; D006423:Hemianopsia / Q000209:etiology; D006801:Humans; D007577:JC Virus / Q000302:isolation & purification*; D019259:Lamivudine; D007968:Leukoencephalopathy, Progressive Multifocal / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates; D010078:Oxazines; D000068698:Tenofovir; D014057:Tomography, X-Ray Computed; D014786:Vision Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014794:Visual Fields
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D063065:Organophosphonates; D010078:Oxazines; D019259:Lamivudine; D000068698:Tenofovir; D000225:Adenine; C098320:efavirenz