TreatmentUpdate81 - Vol. 9, No. 7 - pp. 3-4; September 1997
Sean Hosein

A virus related to small pox called MC (Molluscum contagiosum) can infect the skin, and particularly the face, of PHAs. Infection causes small raised lesions that look like bumps. The virus produces chemicals that hamper the immune system's ability to destroy it. Although MC doesn't normally kill PHAs , the bumps are annoying and can spread. In severe cases the lesions may grow larger.

Treatments that have been used include vitamin A acid gel (Retin-A«, tretinoin), acid peeling, applying electricity to the lesions, DNCB, liquid nitrogen, interferon-alpha, isoprinosine and podophyllin solution. None of these therapies work in every person all the time. Now researchers in the USA have reported that the antiviral drug cidofovir (Vistide«) has helped 3 PHAs recover from MC infection.

Study Details

The first PHA had detectable MC lesions on his face when his CD4+ count was 150 cells. Despite use of vitamin A acid gel and fluorouracil cream the lesions remained and eventually spread to his back, chest and groin. His CD4+ count fell to zero. After 4 months of combination anti-HIV therapy with indinavir, his count increased to 90 cells and viral load fell below 500 copies, but the lesions remained. He also developed CMV infection in his eyes and received intravenous cidofovir (2mg/kg/ 2 weeks) as treatment. After 1 month the number of MC lesions were reduced and after 2 months those on his face and trunk had cleared. Three months after he began use of cidofovir no lesions remained, although he did have scars on his cheeks.

In the 2nd case, the PHA developed "extensive MC lesions involving 95% of his face." At the time his count was 210 CD4+ cells and he was using indinavir as part of his anti-HIV regimen. He was given 3% cidofovir in the form of a cream (made by a local pharmacist) which he placed on his face Monday and Friday for 2 weeks. At first his face became moderately inflamed but this resolved 2 weeks later. One month after applying the cream all his lesions disappeared.

The 3rd PHA also had extensive MC lesions "covering 90% of his face." At the time his CD4+ cell count was 280 cells and he also began to use ritonavir as part of his anti-HIV regimen. Despite this treatment he later developed CMV infection in his eye and he was treated with cidofovir (first at a dose of 5 mg/kg per week for 2 weeks, then it was reduced to 5 mg/kg/2 weeks). Two weeks after starting cidofovir, 50% of his MC lesions cleared and in another 2 weeks the remaining lesions were gone.

Why cidofovir?

Cidofovir has antiviral activity against many herpes viruses. The PHAs in this report had previously used other anti-herpes drugs (acyclovir, foscarnet and ganciclovir), but these had no effect on MC lesions. Cidofovir also has anti-pox virus activity, the group to which MC viruses belong. So perhaps it is not surprising that the drug provided benefit to people with MC lesions. Given these promising results, doctors need to test cidofovir against MC lesions to confirm its effect and to find out how long its benefits lasts.

REFERENCES:

1. Krathwohl MD, Hromas R, Brown DR, et al. Functional characterization of the C--C chemokine-like molecules encoded by molluscum contagiosum virus types 1 and 2. Proceedings of the National Academy of Sciences USA 1997;94:9875-9880.

2. Medows KP, Tyring SK, Pavia AT and Rallis TM. Resolution of recalcitrant Molluscum contagiosum virus lesions in Human Immunodeficiency Virus-infected patients treated with cidofovir. Archives of Dermatology 1997;133:987-990.

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