Methods: This was a pilot study of the clinical efficacy and tolerability of Vicks VapoRubTM among 20 persons aged > 18 years with mycologically confirmed toenail onychomycosis, engaged in care at the HIV Clinics and AIDS Clinical Trials Unit of Washington University. Subjects were recruited between May 2010 and April 2012 and initiated treatment with topically applied Vicks VaporubTM to the affected toenail for a maximum of 24 weeks. Study visits were at baseline, 12, 24, 36 and 48 weeks. For each visit, a digital photograph of the affected toenail was taken, a clinical assessment was made, and adherence to and tolerability of treatment were determined (latter up to week 24). For clinical assessment, the affected nail was overlaid with transparent film. The entire nail plate and the involved nail areas were outlined and transferred to a template. The template was divided into 8x 12.5% segments and the total percentage of involved segments was recorded. The amount of clear nail was determined by the total percentage of involved segments at baseline minus week 24. Non-adherence was defined as <80% of topical applications in a 12 week period.
Results: Overall, 18 (90%) subjects were male, 55% African American with a mean age of 46 years. Nineteen (95%) were on combination antiretroviral therapy with full HIV RNA <50 copies/mL in 61%. Median CD4+ count was 399 cells/mm3 (IQR 278-666). A total of 21 jars of Vicks VapoRubTM were used ($5.38 per unit). Eighteen subjects were seen at week 24, 83% had clearing of their affected nail (median clearance 25% (range 6.3% to 87.5%) and two subjects had total resolution of their infection. Two of 3 subjects with no clearing of the affected nail were non-adherent. No side effects were reported. By week 48, eight of 15 subjects assessed had stable or improved clearance of their affected nail.
Conclusion: Vicks VaporubTM is a cheap, well tolerated and effective alternative treatment of toenail onychomycosis in HIV-infected persons on cART.
M. Klebert, None
W. Seyfried, None
N. Onen, None