Imiquimod (Aldara)

Imiquimod (Aldara) is a drug that stimulates the immune system to produce interferon alfa, a natural chemical that helps the body to fight viruses. It has been approved in Europe and the United States for the treatment of warts and a type of cancer called small superficial basal cell carcinoma. It is available as capsules and a cream.

The cream is applied three times a week for around eight hours, with most patients showing an improvement in symptoms after 16 weeks. The safety of imiquimod cream has not been demonstrated in immunosuppressed patients beyond 16 weeks.

A cream formulation of imiquimod has been studied as a treatment for warts caused by the human papilloma virus. In HIV-negative people, imiquimod has been shown to clear up warts.1 Despite some concerns that immunocompromised patients may not benefit from imiquimod treatment, studies have also suggested that topical imiquimod is an effective treatment for warts and pre-cancerous changes called neoplasia in HIV-infected people, including those taking antiretroviral therapy.2 3 4 5 It may also prevent the recurrence of anal warts after surgical removal, by reducing viral levels in the lining of the anal canal.6

Several reports suggest that imiquimod cream may also be effective for HIV-related molluscum contagiosum.7 8 9

Imiquimod is also being investigated for several HIV-associated conditions and for HIV infection itself. A pilot study found that imiquimod capsules can produce significant increases in CD4 cell counts.10

Side-effects of imiquimod cream include redness, swelling, hardening under the skin, wearing away of the top skin layers, blisters, ulcers, scabbing, pain, burning and itching. Imiquimod capsules have also caused symptoms such as tiredness, temperature, muscle aches, joint pain and malaise, which are thought to be a result of the body producing interferon. These influenza-like side-effects are thought to be unlikely with the cream formulation.

Patients using the cream to treat warts under the foreskin need to wash under the foreskin every day, to prevent tightening of the foreskin.

References

  1. Edwards L et al. Self administered topical 5% imiquimod cream for external anogenital warts. Arch Dermatol 134: 25-30, 1998
  2. Gilson RJ et al. A randomized, controlled, safety study using imiquimod for the topical treatment of anogenital warts in HIV-infected patients. Imiquimod Study Group. AIDS 13: 2397-2404, 1999
  3. Diaz-Arrastia C et al. Clinical and molecular responses in high-grade intraepithelial neoplasia treated with topical imiquimod 5%. Clin Cancer Res 7: 3031-3033, 2001
  4. Cusini M et al. 5% imiquimod cream for external anogenital warts in HIV-infected patients under HAART therapy. Int J STD AIDS 15: 17-20, 2004
  5. Saiag P et al. Efficacy of imiquimod on external anogenital warts in HIV-infected patients previously treated by highly active antiretroviral therapy. AIDS 16: 1438-1440, 2002
  6. Kreuter A et al. 5% imiquimod suppositories decrease the DNA load of intra-anal HPV types 6 and 11 in HIV-infected men after surgical ablation of condylomata acuminata. Arch Dermatol 142: 243-244, 2006
  7. Liota E et al. Imiquimod therapy for molluscum contagiosum. J Med Surg 4: 76-82, 2000
  8. Strauss RM et al. Successful treatment of molluscum contagiosum with topical imiquimod in a severely immunocompromised HIV-positive patient. Int J STD AIDS 12: 264-266, 2001
  9. Brown CW et al. Recalcitrant molluscum contagiosum in an HIV-afflicted male treated successfully with topical imiquimod. Cutis 65: 363-366, 2000
  10. Goldstein D et al. Administration of imiquimod, an interferon inducer, in asymptomatic human immunodeficiency virus-infected persons to determine safety and biologic response modification. J Infect Dis 178: 858-861, 1998

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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.