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Sir, Molluscum contagiosum is a cutaneous skin lesion exclusive to humans, caused by molluscum contagiosum virus (MCV), a DNA virus of the poxvirus family. Among HIV patients, the prevalence of MCV is from 5 to 18% (1). This illness is usually limited and characterized by small, nodule-shaped lesions, indolent and umbilicated, and it can affect every part of the body except the palms and soles (1). The treatment is often unsatisfactory and there is no proven, speci®c antiviral therapy. We describe here a patient with recalcitrant molluscum contagiosum who was resolved with intravenous cidofovir. In November 1996, a 32-year-old man with AIDS (CDC stage C3) and previous history of recurrent pneumonia and pulmonary tuberculosis came to our service because of the appearance of rounded, umbilicated papules and plaques on his face, which subsequently grew in number and size (Fig. 1). A biopsy specimen was examined, and con®rmed the diagnosis of MCV. CD4 cell count was 76 cell/mm and his HIV RNA level was 427,764 copies per ml. From May 1996 to June 1997 he was treated with zidovudine (ZDV) plus zalcitabine (DDC), and from then to November 1997 with ZDV plus lamivudine (3TC) plus saquinavir (SQV). He also received prophylactic therapy against Pneumocystis carinii with trimethoprimÐsulfamethoxazole 3 days a week. The patient had never followed the treatment properly because he usually stopped taking the prescribe medications. Finally all treatment (antiretroviral and prophylaxis) was stopped de®nitively in November 1997, as this was decided by the patient. His lesions were treated in several occasions without success with curettage and podophyllin. In February 1998, he presented with extensive MCV lesions covering more than 60% of his face. This produced in our patient a severe depression, even with a suicide attempt, beginning treatment with paroxetine. Treatment with cidofovir (5 mg/kg once per week followed by 5 mg/kg once every 2 weeks for maintenance therapy) and probenecid (2 g, 3 h before the administration of cidofovir, and 1 g, 2 and 8 h later) was initiated in spite of not having a clear indication due to the great extension of the lesions and his severe depression. Dosage of cidofovir was maintained as renal function was normal. In June 1998, after 9 cycles, the lesions had disappeared (Fig. 2). So far, he is in a complete remission and there is no evidence of MCV, although he refuses any antiretroviral or prophylactic treatment and continues to have severe immunological failure (CD4 count less than 45 cell/ mm and HIV RNA level 1,363,445 copies per ml). MCV is common in HIV-infected patients (1). The occurrence of opportunistic infection occur in 35% of these patients before the diagnosis of MCV, mainly in those patients with a mean CD4 count less than 100 (1). Treatment of MCV in HIV patients is often dif®cult and so far there is no ideal treatment (2). Cidofovir, a nucleotide analogue of deoxycytidine monophosphate with broad spectrum against DNA-viral, is an active treatment against MCV (3). When this drug is given intravenously, its prolonged half-life allows dosing every 2 weeks. Adverse effects associated with cidofovir are nephrotoxicity and, less common, neutropenia, fever and metabolic acidosis. Renal toxicity can be reduced by prehydratation (1 ± 2 l saline) and probenecid, a uricosuric drug that reduces the tubular excretion of cidofovir and so reduces renal dysfunction (4). We began treatment with 5 mg/kg of cidofovir although 2 mg/kg had been employed by Meadows (3), as our patient had good renal function, extensive lesions, and the necessity for a quick resolution because of his severe depression. It is not clear if nucleoside analogues, non-nucleoside analogues or protease inhibitors contributed to the disappearance of the MCV lesions (3), but in our case the patient did not have an effective adherence to the treatment because he refused any antiretroviral treatment. Furthermore, the remission of the MCV did not correlate with either the use of antiretroviral treatment or improvement of the immune status, so in our opinion the remission of the MCV was due to cidofovir. So far, intravenous cidofovir is only indicated in retinitis due to CMV in AIDS patients without renal functional disorder (5). Cidofovir also could be used topically or intralesionally (2, 3, 5), but in extensive lesions intravenous use may be necessary. According to our result and the literature (3), in spite of not having a great experience in the

Efficacy of Cidofovir in the Treatment of Recalcitrant Molluscum Contagiosum in an AIDS Patient