Subject(s)
Embolism, Cholesterol/pathology , Skin/pathology , Aged , Biopsy , Crystallization , Female , Humans , Kidney Diseases/pathology , MaleABSTRACT
BACKGROUND: Treatment options for anogenital warts in patients with HIV-1 are unsatisfactory because they fail to eradicate latent human papillomavirus. 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 pilot 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 placebo. The latter patients eventually received 1% cidofovir cream. Thus, 12 treatment rounds of cidofovir were compared with six rounds of placebo. A reduction 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 reactions occurred in 10 of the 12 patients treated with cidofovir, as compared 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 cream. Local mucosal erosion is a common side effect.
Subject(s)
Antiviral Agents/therapeutic use , Anus Diseases/drug therapy , Cytosine/therapeutic use , Female Urogenital Diseases/drug therapy , HIV Infections/complications , Male Urogenital Diseases , Organophosphonates , Organophosphorus Compounds/therapeutic use , Tumor Virus Infections/drug therapy , Warts/drug therapy , Administration, Cutaneous , Adult , Antiviral Agents/administration & dosage , Anus Diseases/complications , Cidofovir , Cytosine/administration & dosage , Cytosine/analogs & derivatives , Female , Female Urogenital Diseases/complications , Humans , Male , Organophosphorus Compounds/administration & dosage , Patient Satisfaction , Pilot Projects , Single-Blind Method , Treatment Outcome , Tumor Virus Infections/complications , Warts/complicationsABSTRACT
Previous investigations have shown that skin fibroblasts derived from patients affected by Ehlers-Danlos syndrome (EDS) lack an organized extracellular matrix (ECM) of fibronectin (FN). As retarded wound healing is a sign of EDS, we hypothesized that a young healthy man suffering from chronic recalcitrant leg ulcers might be affected by a defect of FN-ECM organization similar to that observed in EDS. Immunofluorescence of cultured skin fibroblasts obtained from skin biopsies from the patient and a control demonstrated that the patient's fibroblasts lacked FN-ECM organization, in contrast with those of the control; this was restored by 10-7 mol/L dexamethasone (DEX) in vitro. DEX treatment of the patient was associated with healing of his leg ulcers. In conclusion, DEX may be effective in reversing impaired wound healing associated with a lack of FN-ECM organization
