Will cidofovir be useful against cervical lesions?

A virus called HPV (human papilloma virus) can cause abnormal growths on the cervix and anus. Some of these growths, over time, can develop into pre-cancerous cells and tumours. Women with HIV are at increased risk for the development of abnormal cells on the cervix and cervical cancer. Cervical lesions are usually removed by surgery. In this report we present findings from Belgium on the use of cidofovir (Vistide) for the treatment of pre-cancerous cervical lesions.

Doctors in Belgium enrolled 15 women, none of whom had HIV infection, for this study. The average age was 33 years and all had cervical lesions that were likely to become cancerous. Lab testing indicated that the lesions were producing HPV. Subjects received “three applications, every other day, of 3 grams cidofovir 1% gel on the cervix” applied by a gynaecologist. About two weeks after the start of cidofovir therapy, the lesions were surgically removed and examined to find out the effect of cidofovir on their growth.

In about half the subjects (seven of 15), cidofovir severely damaged the lesions. In four of these seven subjects technicians could no longer detect HPV. In the remaining seven the response to cidofovir was, at best, limited. Indeed, the lesions from these seven women continued to produce HPV. The researchers reported that cidofovir caused no apparent toxicity.

Cidofovir was first developed as a treatment for CMV. Innovative doctors have used this drug to treat other AIDS-related complications such as PML (progressive multifocal leukoencephalopathy) and mollusca lesions. Now it appears that cidofovir also has anti-HPV activity in some women. For cidofovir to be more useful, future research needs to look at the effect of higher doses or more frequent application. Perhaps even a new formulation needs to be developed to ensure that the drug can penetrate deeper into the cervix and other tissues.

Ref: Snoeck R, Noel J-C, Muller C, et al. Cidofovir, a new approach for the treatment of cervical intraepithelial neoplasia grade III (CIN III). Journal of Medical Virology 2000;60:205-209.

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