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Smallpox: Experts Debate Anti-Viral Drug as Treatment U.S. health officials are debating whether an anti-viral drug currently used as an AIDS treatment should also be stockpiled for use in the event of a smallpox attack, the Wall Street Journal reported today (see GSN, March 15). The anti-viral drug Vistide, generically known as cidofovir, is currently used to treat some AIDS patients to prevent the onset of blindness. In test-tube and animal studies cidofovir also has been shown to be effective in preventing smallpox, according to the Journal. Cidofovir “continues to look good,” said James LeDuc of the U.S. Centers for Disease Control and Prevention. The U.S. Food and Drug Administration and the U.S. Army Medical Research Institute of Infectious Diseases have also offered support for experimental use of cidofovir against smallpox. Office of Public Health Preparedness Director D.A. Henderson, however, supports containing a smallpox outbreak through vaccination, the Journal reported (see GSN, Feb. 6). That approach seeks to halt the spread of the disease by vaccinating those who come into contact with an infected person. The smallpox vaccine does not treat those who are already infected — who could either die from the disease or be left with lasting scars, according to the Journal. The mortality rate of smallpox is 30 percent, which has caused some researchers to support using cidofovir to complement the vaccine, the Journal reported. Henderson, who had a vital role in the World Health Organization’s efforts to eradicate smallpox, said he is skeptical about using cidofovir to combat smallpox and he opposes devoting resources to uncertain treatments. It is “an experimental drug,” Henderson said. “After an individual comes down with fever and rash, would we be able to treat them? We’d be better off looking at treating (vaccine) complications,” he said. “That’s the most prudent way to go about this.” Cidofovir has other drawbacks besides being experimental, according to the Journal. It requires intravenous delivery and can do damage to a person’s kidneys if used over a long period. The drug is also expensive, currently costing $705 wholesale for a single dose. Cidofovir supporters said Henderson’s opposition to the drug’s use, combined with his clout as head of the Office of Public Health Preparedness, could limit promising research into the drug’s use as a smallpox treatment. “D.A. did an important thing” in his work with the WHO to wipe out smallpox, said USAMRIID researcher John Huggins. “But he doesn’t understand anti-virals. I wish he’d give us a fair shake” (Marilyn Chase, Wall Street Journal, March 19).
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