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S of pml, with enlarged oligodendroglial nuclei and intranuclear ground glass-type inclusions. In situ hybridization for jc viral genome sequences was positive and the jc viral load was reported as 3600 copies/ml. Because of the pml diagnosis, hiv screening, t cell subset cell count and immunoglobulin tests were carried out. viagra for sale viagra without a doctor prescription cheap generic viagra cheap generic viagra cheap viagra online cheap generic viagra buy viagra viagra without a doctor prescription Serological tests by elisa and pcr analysis were negative for hiv-1, hiv-2 and human t-lymphotropic virus-1 and -2, and immunoglobulin studies were normal (igg total 974 mg/dl, igg1 501 mg/dl, igg2 217 mg/dl, igg3 64 mg/dl, igg4 4 mg/dl, iga 350 mg/dl and igm 210 mg/dl). Initial t cell counts were markedly decreased at 87 and 111 cells/mm3. Based upon these results, a diagnosis of pml with icl was made and the challenge of creating an appropriate treatment regimen began. After a discussion of potential options and a review of published literature, as described in the accompanying review article, 1 therapy was initiated with three main goals: (i) to decrease jc virus levels; (ii) to increase cd4+ cell counts; and (iii) to prevent other opportunistic infections. Because the available options for the treatment of pml are limited and published data are based on case reports, it was decided to provide a combination of agents shown to be active against jc virus. The patient was started on cidofovir [5 mg/kg intravenous (iv) ã—2 weeks], risperidone (2 mg orally every 12 h) and mefloquine (250 mg orally ã—3 days, then weekly). An investigational oral agent for the treatment of pml, cmx001, was given to the patient after the initial 2 weeks of iv cidofovir. The patient also received an investigational interleukin-7 (cyt107) to increase their cd4+ cell counts. Initiation of this therapy was delayed until viral loads decreased, in order to avoid immune reconstitution syndrome. Finally, the patient was given appropriate prophylaxis with dapsone (100 mg orally daily), according to cdc recommendations for a cd4+ count of <200 cells/mm3. Four weeks after the initiation of therapy for jc virus with risperidone, iv cidofovir and mefloquine, the patient's serum viral load was 3456 copies/ml. The patient's neurological function was declining, as their left hand started becoming weaker and they had difficulty swallowing and speaking. Repeat mri showed a new area of dysfun.