Cidofovir is a nucleotide analogue which inhibits viral DNA polymerase
and is effective against human cytomegalovirus (CMV) infection. It is
phosphorylated to its active form by cellular enzymes. With the long
intracellular half-life of its metabolites, cidofovir can be administe
red weekly during induction and every other week during maintenance th
erapy. Viral resistance has not been documented in patients treated wi
th cidofovir to date, but has developed in vitro. Immediate cidofovir
therapy delayed progression of CMV retinitis compared with deferred tr
eatment in patients with AIDS. Cidofovir also delayed the progression
of CMV retinitis relapsing after previous treatment. To avoid nephroto
xicity, probenecid and intravenous saline hydration must be administer
ed with each dose of cidofovir.