Efficacy and tolerability of topical 1% cidofovir cream for the treatment of external anogenital warts in HIV-infected persons

Background: Treatment options for anogenital warts in patients with HIV-1 a re unsatisfactory because they fail to eradicate latent human papillomaviru s. Goal: To determine tolerability and efficacy of topical 1% cidofovir cream for the treatment of external anogenital warts in HIV-infected patients. Study Design: A randomized, placebo-controlled, single-blind, crossover pil ot study of either 1% cidofovir cream or placebo applied once daily 5 days a week for 2 weeks followed by 2 weeks of observation was performed. Results: Six patients were randomized to 1% cidofovir cream and six to plac ebo. The latter patients eventually received 1% cidofovir cream. Thus, 12 t reatment rounds of cidofovir were compared with six rounds of placebo. A re duction of more than 50% in the total wart area achieved by seven cidofovir treatments (58%), as compared with no placebo regimen (P = 0.02), Local re actions occurred in 10 of the 12 patients treated with cidofovir, as compar ed with 0 of the 6 subjects in the placebo group (P < 0.001), Conclusions: For the initial clearance of anogenital warts in HIV-infected patients, 1% cidofovir cream is significantly more effective than vehicle c ream. Local mucosal erosion is a common side effect.