[Jim Noble]

I have used a fair amount of cidofovir to treat CMV.

It is very difficult to use-it is IV (intravenous) only, and causes major side effects, including kidney failure severe enough to require discontinuation, in over 50% of those treated.

The IV infusion itself is difficult and prolonged.

I am interested in the reference to ribavirin, which is used to treat Hepatitis C and is now available in large quaantities both here and overseas.

[dandelion]

Does that rate of kidney failure reflect those patients taking Probenecid? I understand that the rate of kidney failure is quite high in those patients who are not taking Probenecid, I'm curious to the renal failure rate of those who take Cidofovir with Probenecid. Probably no one would prescribe it WITHOUT Probenecid, but I'm not sure if their are contraindications for HIV patients to take Probenecid...

[dandelion]

This in response to the difficulty in administration, and in the need to discontinue due to renal side effects:

According to this document, the dosage would be a one-time IV within 48 hours of exposure: 5 mg/kg IV over 1 h. This vastly differentiates smallpox treatment with cidofovir from the treatment of CMV with the same, since treatment of CMV is ongoing for the life of the patient. According to this study, they believe this one-time, one-hour IV dose will significantly attenuate or even avoid infection with smallpox if administered within 48 hrs of infection - certainly worth the difficulty of administration, and certainly worth the risk of renal damage if administered with proper accompanying medications (probenecid)...

[dandelion]

Ribavirin may be the ONLY option for pediatric care - I'm not sure if Cidofovir would be indicated at any level for children. It bears looking into the matter more deeply - is this drug widely available?