Topical Imiquimod Therapy for Chronic Giant Molluscum Contagiosum in a Patient With Advanced Human Immunodeficiency Virus 1 Disease

A 32-year-old African American woman with human immunodeficiency virus 1 (HIV-1) and a 3-year his- tory of extensive facial molluscum contagiosum (MCV) presented to the dermatology clinic for treatment. The patient had been treated with multiple therapies, including liquid nitrogen, topical 0.05% liquid treti- noin, and 0.5% topical podofilox, with no improve- ment and some secondary irritation to the latter 2 therapies. At her initial appointment, she was taking nelfina- vir mesylate (Viracept), 750 mg 3 times daily; stavudine (Zerit), 40 mg twice daily; didanosine (Videx), 200 mg twice daily; trimethoprim-sulfamethoxazole (Bactrim DS), 800 mg/160 mg every day; and fluconazole (Diflucan), 100 mg every day. She had been receiving nelfinavir, stavu- dine, and didanosine for 5 months and trimethoprim- sulfamethoxazole and fluconazole since shortly after her diagnosis 3 years earlier. Her CD4 T-cell count was 0.004 3 109/L (38/mm3) and the viral load (Roche Am- plicor HIV-1 RNA-polymerase chain reaction (RNA- PCR)) was at 2900 RNA copies/mL. This represented an approximately 1.5 log reduction in her initial viral load and had remained relatively stable during the past few months. On examination, there were papules and large nod- ules and plaques predominantly on the face. They ranged in size from 3 to 20 mm, with areas of depressed scar- ring a nd p ostinflammatory h yperpigmentatio n