PML and AIDS
When progressive multifocal leukoencephalopathy (PML) occurs in patients with acquired immunodeficiency syndrome (AIDS), the average survival rate is six months. PML, a disease caused by the John Cunningham (JC) virus, is an infection of the brain that is almost always fatal within months. The virus is an opportunistic infection that takes advantage of persons with weakened immune systems.
The JC virus exists in most people in a latent state until the immune system is severely compromised. When this happens, the virus becomes activated and travels to the brain where it attacks the myelin, a protective white coating of the nerves that gives the name to the white matter in the brain. The disease may begin slowly but progresses relentlessly, eventually causing death in a matter of months.
Many people with PML have HIV or AIDS because their immune systems are weak. Since the AIDS virus was first recognized, the disease has increased five-fold.
The disease does occur in other patients whose immune systems also are weakened. These include patients taking drugs that weaken the immune system, including those with multiple sclerosis, Crohn's disease, rheumatoid arthritis, systemic lupus erythematosus, non-Hodgkin's lymphoma, moderate to severe plaque psoriasis and those taking certain medications to suppress the immune system in the case of organ transplantation. These medications include Tysabri®, Rituxan™, Raptiva®, CellCept and Myfortic.
Symptoms of PML
PML may begin slowly. The arms and legs, usually on one side of the body become weak. Then, as the virus progressively destroys more myelin, the following symptoms appear:
- Difficulty seeing properly
- Trouble balancing
- Speech and language difficulties
- Trouble understanding someone else's speech
- Difficulty walking
- Mental problems
- Changes in personality
In addition to considering the symptoms of PML, there are other ways to diagnose the disease. These include doing certain tests and procedures, such as:
- Testing for the JC virus in the cerebrospinal fluid
- Doing a biopsy of the brain (This is rarely done.)
- Using certain imaging technologies such as computed tomography (CT) scan of the brain or molecular resonance image (MRI) of the brain
- Conducting an electroencephalogram (EEG)
Knowing When to See Your Doctor
PML occurs only in certain patients. If you have AIDS or HIV and begin to display the progressive symptoms of the disease, you should visit your doctor. The physician may be able to change your medication to affect the progression of PML.
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