Mirtazapine use in human immunodeficiency virus-infected patients with progressive multifocal leukoencephalopathy.
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.
Cettomai
Deanna
D
Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
McArthur
Justin C
JC
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
D011985:Receptors, Serotonin; D012702:Serotonin Antagonists; D008803:Mianserin; D000078785:Mirtazapine