Cidofovir added to HAART improves virological and clinical outcome in AIDS-associated progressive multifocal leukoencephalopathy

Abstract

In AIDS-related PML, cidofovir added to HAART is associated with a more effective control of JCV replication, with improved neurological outcome and survival compared with HAART alone.

Progressive multifocal leukoencephalopathy after stem cell transplantation, unsuccessfully treated with cidofovir

“…To assess this possibility some studies have compared the treatment of PML patients with HAART alone and HAART plus cidofovir. A higher rate of JC virus DNA neutralization in the CSF, and a better outcome has been found in some, 15,17 but not all cidofovir studies. 16 Cidofovir is generally well tolerated, and the most common reported adverse effects are nephrotoxicity (manifested usually as proteinuria), vomiting, neutropenia and ocular hypotony.…”

“…This is also supported by the fact that even in the transplant patients with the lowest CD4 counts, these were not as low as in HIV patients with PML. [15][16][17] Most patients with HIV infection and PML have CD4 counts less than 100/mm 3 .…”

“…This antiviral agent, with in vitro activity against Papovaviridae, has been used in patients with HIV and PML with some favorable outcomes. 15,[17][18][19] However, the improvement observed in HIV patients may be due to the effect of concomitant highly active antiretroviral therapy (HAART). To assess this possibility some studies have compared the treatment of PML patients with HAART alone and HAART plus cidofovir.…”

Progressive Multifocal Leukoencephalopathy

“…Similarly, treatment with beta-interferon, an inhibitor of viral replication, yielded variable results [81,82]. The effect of cidofovir, an antiviral drug and inhibitor of viral replication on PML was variable [83,84]. Further, clathrin-mediated endocytosis [38] inhibitor, chlorpromazine, acting singly or in combination with clozapine showed some prospect on glial cell culture in vitro [85] but it was of little or no benefit in clinical trial in vivo [69].…”

Leflunomide an Immunosuppressive Drug for Antiviral Purpose in Treatment for BK Virus-Associated Nephropathy After Kidney Transplantation

“…The immunosuppressive regimen strength, with high level blood concentrations, is the first factor involved. Most patients affected by BK virus-associated nephropathy previously had an intensification of immunosuppressive regimen due to a rejection event or a treatment including tacrolimus and/or mycophenolate mofetil www.intechopen.com combined with monoclonal or polyclonal antibodies (De Luca et al 2000;Nickeleit et al 2000b;Randhawa et al 2000;Hirsch et al 2001). Conversely, no cases have been reported in patients treated with cyclosporine and corticosteroids Mengel et al 2003).…”