A 40-year-old man with HIV (CD4 30/μL) on ART develops progressive multifocal leukoencephalopathy (PML) confirmed by JC virus PCR in CSF. What is the primary treatment strategy for PML in HIV?

• A Cidofovir antiviral therapy
• B High-dose cytarabine intrathecally
• C Rituximab to target JC-virus-infected B cells
• D Optimize/initiate ART to achieve immune recovery ✓

Explanation

PML in HIV is caused by JC virus-mediated lytic infection of oligodendrocytes occurring with profound immunosuppression. The primary and only proven treatment strategy is to restore immune competence by optimizing ART to achieve viral suppression and CD4 recovery. No antiviral has proven efficacy against JC virus; cidofovir, cytarabine, and mirtazapine have all failed in clinical trials. PML-IRIS (immune reconstitution inflammatory syndrome) can worsen radiological appearance despite clinical stability after ART initiation and is treated with corticosteroids.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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