In response to an email request for more information on the following case report:
Maruszak H, Brew BJ, Giovannoni G, Gold J. Could antiretroviral drugs be effective in multiple sclerosis? A case report. Eur J Neurol. 2011 Sep;18(9):e110-1. doi: 10.1111/j.1468-1331.2011.03430.x.
This is a case report of a man aged 26 who was diagnosed with possible MS in 1985 within several months of an initial confirmation of acute HIV-1 infection. Over subsequent years his neurological deficits and clinical investigations confirmed the diagnosis of RRMS. RRMS episodes were treated with systemic steroids with some effect. The patient could not tolerate interferon beta or glatiramer acetate therapy. The multiple system presentation of the RRMS, his young age and frequency of episodes all predicted a poor prognosis for his MS. During this period, the patient’s HIV condition remained asymptomatic and stable with a CD4 T cell count within normal limits and relatively moderate HIV viral load (<20,000 copies/ml). After 10 years from his acute HIV infection with an HIV RNA viral load of 19,000 copies/ml and a CD4 T cell count of 400 cells/ml (normal 500-1000 cells/ml) the patient was commenced on a highly active antiretroviral therapy (HAART) regimen with drugs known to have good central nervous system (CNS) penetration. In the past 14 years since he has been on HAART he has suffered no further neurological episodes.
"Why is this case report important?"
"It is very important for several reasons. Firstly, we don't know what causes MS and several people have proposed over the years that MS is due a virus and more specifically a retrovirus. This is not a new hypothesis."
"If MS is due to a retrovirus the possible impact of HAART on the course of MS in this case cannot be ignored."
"Should we not explore this further?"
"This is another example of why case reports are so important."
CoI: Julian Gold is an honorary Professor in our unit and I'm a co-author on this paper.
Other articles of interest: