A 28-year-old HIV-positive patient (CD4 count 80 cells/μL) develops extensive disfiguring molluscum contagiosum involving the face. The most appropriate management is:

• A Initiation or optimization of antiretroviral therapy (ART) to restore CD4 count ✓
• B Imiquimod 5% cream applied daily for 16 weeks
• C Cryotherapy to all individual lesions
• D Intralesional cidofovir injection into each lesion

Explanation

Extensive, giant, or refractory molluscum contagiosum in HIV patients is an AIDS-defining opportunistic condition indicating profound immune suppression (CD4 <100). Unlike in immunocompetent individuals where MC is self-limiting, in AIDS patients it persists and spreads extensively especially on the face due to shaving. The most effective long-term strategy is immune reconstitution through effective antiretroviral therapy — as CD4 count rises, the immune system clears MCV infection and lesions spontaneously resolve. Physical destruction (cryotherapy, curettage) is palliative and cannot keep up with new lesion formation at CD4 <100. Imiquimod has limited efficacy in profoundly immunosuppressed patients.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.