title: Mirtazapine use in human immunodeficiency virus-infected patients with progressive multifocal leukoencephalopathy.
abstract: BACKGROUND
  An efficacious treatment is needed for human immunodeficiency virus (HIV)-infected and uninfected patients with progressive multifocal leukoencephalopathy (PML).
  
  
  OBJECTIVE
  To report clinical and magnetic resonance imaging changes in response to mirtazapine treatment in HIV-positive patients with PML.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Outpatient neurology clinic.
  
  
  METHODS
  Four HIV-positive patients with PML.
  
  
  METHODS
  Mirtazapine use, 15 mg nightly.
  
  
  METHODS
  Neurologic examinations and cranial magnetic resonance imaging.
  
  
  RESULTS
  Three patients demonstrated objective clinical improvement, and 1 patient showed improvement on magnetic resonance imaging. The patient who experienced the most significant clinical improvement was the patient who received mirtazapine therapy closest to PML symptom onset. Mirtazapine use was safe and well tolerated.
  
  
  CONCLUSIONS
  Mirtazapine use may offer some benefit as treatment or prophylaxis for PML in patients with HIV infection.
authors.affiliation: Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors.forename: Deanna
authors.initials: D
authors.lastname: Cettomai
authors.forename: Justin C
authors.initials: JC
authors.lastname: McArthur
mesh_terms: D000328:Adult; D001812:Blood-Brain Barrier / Q000187:drug effects / Q000378:metabolism; D001921:Brain / Q000187:drug effects / Q000473:pathology; D004334:Drug Administration Schedule; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008803:Mianserin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D008875:Middle Aged; D000078785:Mirtazapine; D011985:Receptors, Serotonin / Q000187:drug effects / Q000378:metabolism; D012702:Serotonin Antagonists / Q000008:administration & dosage* / Q000493:pharmacokinetics; D016896:Treatment Outcome
chemical_list: D011985:Receptors, Serotonin; D012702:Serotonin Antagonists; D008803:Mianserin; D000078785:Mirtazapine