Cidofovir inhibits viral DNA polymerase, interfering with CMV replication.

VISTIDE is indicated for the treatment of CMV retinitis in patients with acquired immunodeficiency syndrome (AIDS).

5 mg/kg IV once weekly for 2 weeks.

Nephrotoxicity (59% of patients): Requires dose adjustment or discontinuation.

Neutropenia (24%), ocular hypotony, metabolic acidosis, and uveitis/iritis.

Animal studies showed carcinogenicity, reproductive toxicity, and teratogenicity.

Preexisting kidney dysfunction: Creatinine >1.5 mg/dL, CrCl ≤55 mL/min, or proteinuria ≥2+.

Use with nephrotoxic drugs.

Severe hypersensitivity to probenecid or sulfa drugs.

Intraocular use is strictly contraindicated

Renal toxicity is the primary risk.

• Acute renal failure, sometimes requiring dialysis or leading to death, has occurred after just 1–2 doses.

• Hydration with saline and co-administration of probenecid are required to mitigate this risk.

Neutropenia and ocular issues (hypotony, iritis) are also associated with treatment.

Use is limited to CMV retinitis in AIDS patients only.