Cidofovir
Cidofovir is an acyclic nucleoside phosphonate currently used to treat cytomegalovirus retinitis in HIV patients. It has been shown to have activity against a large number of viruses, including herpes viruses and human papillomavirus.[64]Snoeck R, Van Ranst M, Andrei G, et al. Treatment of anogenital papillomavirus infections with an acyclic nucleoside phosphonate analogue. N Engl J Med. 1995 Oct 5;333(14):943-4.
http://www.ncbi.nlm.nih.gov/pubmed/7666893?tool=bestpractice.com
[65]Orlando G, Fasolo MM, Beretta R, et al. Intralesional or topical cidofovir (HPMPC, VISTIDE) for the treatment of recurrent genital warts in HIV-infected patients. AIDS. 1999 Oct 1;13(14):1978-80.
http://www.ncbi.nlm.nih.gov/pubmed/10513659?tool=bestpractice.com
[66]Schurmann D, Bergmann F, Temmesfeld-Wollbrück B, et al. Topical cidofovir is effective in treating extensive penile condyloma acuminata. AIDS. 2000 May 26;14(8):1075-6.
http://www.ncbi.nlm.nih.gov/pubmed/10853999?tool=bestpractice.com
One study reported complete resolution of warts in 93% of HIV-positive patients treated with surgery alone, 76% treated with cidofovir alone, and 100% of people treated with combination therapy.[59]Orlando G, Fasolo MM, Beretta R, et al. Combined surgery and cidofovir is an effective treatment for genital warts in HIV-infected patients. AIDS. 2002 Feb 15;16(3):447-50.
https://journals.lww.com/aidsonline/fulltext/2002/02150/combined_surgery_and_cidofovir_is_an_effective.17.aspx
http://www.ncbi.nlm.nih.gov/pubmed/11834957?tool=bestpractice.com
The combination treatment group also had the lowest relapse rate (27%), compared with the single-treatment groups.[59]Orlando G, Fasolo MM, Beretta R, et al. Combined surgery and cidofovir is an effective treatment for genital warts in HIV-infected patients. AIDS. 2002 Feb 15;16(3):447-50.
https://journals.lww.com/aidsonline/fulltext/2002/02150/combined_surgery_and_cidofovir_is_an_effective.17.aspx
http://www.ncbi.nlm.nih.gov/pubmed/11834957?tool=bestpractice.com
Studies have also shown topical cidofovir to be effective in treating refractory genital warts. Cidofovir has been compounded in bases for topical use, although topical formulations are prohibitively expensive. Although application site reactions are common and may be severe, no significant systemic side effects have been noted.[67]Zabawski EJ, Cockerell CJ. Topical and intralesional cidofovir: a review of pharmacology and therapeutic effects. J Am Acad Dermatol. 1998 Nov;39(5 Pt 1):741-5.
http://www.ncbi.nlm.nih.gov/pubmed/9810890?tool=bestpractice.com
Ongoing studies are needed to confirm the initial reports regarding its therapeutic efficacy and lack of systemic side effects.