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Natalizumab (Nz) a monoclonal antibody has been in medicinal use for treatment of Relapsing Remitting Multiple Sclerosis (RRMS) since 2004. Progressive Multifocal Leukoencephalopathy (PML) is one of its serious risks which is a demyelinating disorder of brain associated with John Cunningham Virus (JCV). There have been 801 cases up till December 2018 which were reported with its use1. Lack of prospective trials and retrospective studies due to small number of these cases there is no consensus on Nz-associated PML treatment. To date there is no cure for this condition and there is a debate on effectiveness of different modalities2. Cidofovir an antiviral drug which is used in cytomegalovirus retinitis, Aciclovir-resistant HSV infections3, 4. The antiviral properties of Cidofovir are attributed to its active metabolite Cidofovir diphosphate which inhibits viral replication by impeding viral DNA ploymerases 5. Cidofovir is effective in polyomavirus like BK-virus in kidney transplant recipients. JCV belongs to the same family of Polyomaviruses5. Cidofovir has been used in selected cases with PML in various immunosuppressed states, hematological malignancies, post-transplant and HIV for the treatment of PML. This CAT aims to look at the evidence for using Cidofovir in Nz-associated PML

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