Topical cidofovir clears severe molluscum contagiosum in children with AIDS

Topical 3% cidofovir was successful in clearing disseminated molluscum contagiosum refractory to other treatment in 2 children with AIDS, according to Dr Jorge R. Toro and colleagues from the National Cancer Institute in Bethesda, Md.

Previous treatments had included liquid nitrogen, cantharidin, and tretinoin gel. Both patients had been on highly active antiretroviral therapy (HAART) for a median of 24 months.

The facial lesions were so disfiguring that the patients, an 8-year-old boy and a 4-year-old boy, experienced severe social isolation. The CD4 T-cell counts were 329 and 168 cells/µL, with viral loads of log 5.86 and log 5.63 HIV RNA copies/mL, respectively.

In an interview with Reuters Health, Dr Toro pointed out that “If you’re treating patients with HAART and the viral load doesn’t go down, then you are talking about a very resistant kind of situation.”

Cidofovir was mixed with Dermovan, a combination vehicle containing propylene glycol, and applied to lesions once a day, 5 days a week, for 8 weeks. Nonfacial and nonmucosal lesions were also occluded with adhesive tape for at least 12 hours at each application, Dr Toro told Reuters Health.

Five to 15 days after beginning the cidofovir treatment, both boys exhibited redness and painful erosions at the sites of the previous lesions, although surrounding skin was unaffected. “After 2 months of treatment, all the lesions that were treated showed complete clinical resolution,” the investigators write.

“The success of treatment is very dependent on the vehicle,” Dr Toro said. He explained that a commercially available preparation of 1% cidofovir uses a completely different vehicle. “For patients using that specific type, it didn’t work,” he said, adding that “It has to be compounded in this particular vehicle and it has to be fresh and it has to be kept refrigerated.

“We saw 1 of the boys 2 weeks ago, and there’s been no recurrence of any lesions after more than 2 years,” Dr Toro said.