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Chapter 26 : Progressive Multifocal Leukoencephalopathy in the Era of HAART
Category: Viruses and Viral Pathogenesis
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Progressive multifocal leukoencephalopathy (PML) is an important viral infection of the central nervous system that has attracted increasing attention in recent years because of the surge in incidence accompanying the epidemic of the human immunodeficiency virus (HIV). An interesting problem raising concern among neuro-AIDS experts has been the development of an increasing number of serious, undiagnosed white matter conditions in the setting of highly active antiretroviral therapy (HAART). Clinical presentations of PML are also helpful in suggesting the diagnosis. While the disease is often pathologically multifocal, it is most commonly clinically characteristic of a progressive focal disease. Analysis of the cerebrospinal fluid (CSF) has been complementary to examination and magnetic resonance (MR) scanning and has improved the sensitivity and specificity to the point that in most cases, even for research purposes, a brain biopsy does not appear to be necessary. Numerous case reports of cytosine arabinoside (cytarabine) treatment associated with disease arrest were included in the literature through the years. PML remains an important challenge for clinicians and researchers. Increasing ability to detect and tract the activity of this ubiquitous virus will enhance our understanding of its pathobiology.
Key Concept Ranking
- Highly Active Antiretroviral Therapy