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

Abstract

A 32-year-old African American woman with human immunodeficiency virus 1 (HIV-1) and a 3-year history 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 tretinoin, and 0.5% topical podofilox, with no improvement and some secondary irritation to the latter 2 therapies. At her initial appointment, she was taking nelfinavir 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, stavudine, and didanosine for 5 months and trimethoprimsulfamethoxazole and fluconazole since shortly after her diagnosis 3 years earlier. Her CD4 T-cell count was 0.004 3 10/L (38/mm) and the viral load (Roche Amplicor HIV-1 RNA–polymerase chain reaction [RNAPCR]) 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 nodules and plaques predominantly on the face. They ranged in size from 3 to 20 mm, with areas of depressed scarring and postinflammatory hyperpigmentation (Figure 1).