skip to main content

PML — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

ModerateImmunocompromised HostPMLSCE Infectious Diseases

A 39-year-old woman with HIV (CD4 15 cells/µL) presents with progressive multifocal subcortical white matter lesions on MRI. CSF JC virus PCR is positive at 12,500 copies/mL. She is not on ART. What is the most important therapeutic intervention?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Initiate ART to achieve immune reconstitution

There is no proven direct antiviral therapy for PML. The only intervention shown to improve survival is immune reconstitution through ART initiation. The risk of PML-IRIS (worsening inflammation as immune function recovers) must be anticipated — it occurs in approximately 20% and may require corticosteroids. Cidofovir, Cytarabine, and Mirtazapine have all been studied but none have demonstrated consistent benefit in clinical trials.

Reference: BHIVA 2022 – OI guidelines; Cochrane 2023 – Interventions for PML