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Deanna Cettomai, BS; Justin C. McArthur, MBBS, MPH

Arch Neurol. 2009;66(2):255-258.

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.

Design  Case series.

Setting  Outpatient neurology clinic.

Patients  Four HIV-positive patients with PML.

Interventions  Mirtazapine use, 15 mg nightly.

Main Outcome Measures  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.

Conclusion  Mirtazapine use may offer some benefit as treatment or prophylaxis for PML in patients with HIV infection.

Author Affiliations: Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.

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