Use Of Cidofovir Research Articles

Progressive Multifocal Leukoencephalopathy and Idiopathic CD4+Lymphocytopenia: A Case Report and Review of Reported Cases

Progressive multifocal leukoencephalopathy (PML) is a well recognized demyelinating neurological disorder caused by JC virus. Idiopathic CD4(+) lymphocytopenia (ICL) is a syndrome first described by the Centers for Disease Control and Prevention as a CD4(+) count <300 cells/mm(3) or a CD4(+) count that is <20% of the total T cell count on 2 occasions, with no evidence of human immunodeficiency virus (HIV) infection on testing, and absence of any defined immunodeficiency or therapy that depresses the levels of CD4(+) T cells. To the best of our knowledge, this is the third reported case of PML and ICL, and also the first reported case of the use of cidofovir to treat PML in a patient not infected with human immunodeficiency virus.

Progressive Multifocal Leukoencephalopathy.

Before embarking on experimental therapies for progressive multifocal leukoencephalopathy (PML), the diagnosis needs to be unequivocally established. Improving the underlying immunodeficiency state is the best initial approach to the management of PML. Immunosuppressive therapies should be discontinued when feasible. In the patient with AIDS, highly active antiretroviral therapy should be administered; this appears to prolong survival. At present, no therapy has been demonstrated to be effective in a well-designed prospective trial. Cytosine arabinoside, which has demonstrated efficacy in vitro against JC virus, has not been effective when administered intravenously or intrathecally to patients with AIDS and PML. The failure of regimens employing cytosine arabinoside in PML may have been the consequence of inadequate penetration of the drug to sites of infection in the brain. Other drugs with established in vitro activity against JC virus, such as topoisomerase and camptothecin, are poorly tolerated. The use of cidofovir in patients with AIDS and PML remains anecdotal, although it is currently under investigation. Interferon alfa may improve survival in patients with AIDS and PML and may have general applicability to PML regardless of the cause of the underlying immunodeficient state. Approximately 7% to 9% of patients with PML demonstrate prolonged survival (>12 months) and associated improvement in clinical and radiographic abnormalities in the absence of specific therapy. In patients with AIDS-related PML, prolonged survival correlates with PML as the presenting manifestation of AIDS, higher CD4 T-lymphocyte counts, and contrast enhancement of PML lesions on radiographic imaging. A brisk inflammatory response may also be associated with improved survival. The increased understanding of the pathophysiology of JC virus provides hope for the development of curative strategies. The growing number of persons affected with PML has allowed the organization of carefully designed therapeutic trials to address this issue.

Anterior uveitis associated with intravenous cidofovir use in patients with cytomegalovirus retinitis

AIMIntravenous cidofovir is used to treat cytomegalovirus (CMV) retinitis, and has been reported to cause anterior uveitis. Relations were sought between this complication and patient characteristics that might help predict...

Topical and intralesional cidofovir: A review of pharmacology and therapeutic effects

Background: Cidofovir is a potent nucleoside analog antiviral drug approved for the treatment of cytomegalovirus (CMV) retinitis in patients with AIDS. It is currently available only for intravenous infusion. Several small studies and case reports describe the successful use of cidofovir applied either topically or intralesionally in several virally induced cutaneous diseases. Objective: Our purpose was to review the usefulness of topical and intralesional cidofovir for the treatment of viral infections caused by human papillomavirus, herpesviruses (including acyclovir-resistant strains), Kaposi’s sarcoma–associated herpesvirus, and molluscum contagiosum. Methods: We performed a review of recent literature. Results: Cidofovir is a potent topical intralesional antiviral agent with activity against several DNA viruses that cause cutaneous disease. No significant systemic side effects have been noted, although application site reactions are common and can occasionally be severe. Conclusion: The effective use of topical and intralesional cidofovir for the treatment of diseases of the skin caused by DNA viruses has been demonstrated in a limited number of patients including those infected with HIV. Although larger studies will be necessary to determine the specific function that topical cidofovir will have in the treatment of cutaneous diseases caused by DNA viruses, the drug offers significant promise. (J Am Acad Dermatol 1998;39:741-5.)

Nursing Considerations in the use of Cidofovir for CMV Retinitis in Patients with AIDS: Report of a Roundtable Meeting

Cytomegalovirus (CMV) retinitis, a late complication of infection with HIV, generally leads to blindness if untreated. Although the retinal damage from CMV cannot be reversed, disease progression can be arrested with any one of three antiviral agents, which must be continued indefinitely. Intravenous ganciclovir and foscarnet, the earliest therapies, must be administered every day and require placement of an indwelling catheter. Cidofovir, a newly introduced intravenous antiviral, requires the least frequent administration; after two once-a-week induction doses, maintenance therapy is given only once every other week. However, cidofovir is potentially nephrotoxic and must be coadministered with nephroprotective probenecid and saline hydration. Careful adherence to treatment administration guidelines for cidofovir and probenecid is essential for safe administration of both drugs. Averting and managing adverse reactions to cidofovir and probenecid may present a true nursing challenge; however, with proper patient selection and appropriate use, cidofovir has the potential to greatly enhance the quality of life of a patient with CMV retinitis.