A controlled trial of early versus late treatment with zidovudine in symptomatic human immunodeficiency virus infection

Article Abstract:

Treating HIV-infected patients with zidovudine (AZT) early in the course of the infection may delay the onset of AIDS, but it can cause more side effects and may not improve survival. Of 338 patients with documented HIV infection and CD4+ counts between 200 and 500 per cubic millimeter, 170 began taking 1,500 milligrams of zidovudine each day (the early-treatment group) and 168 started treatment when their CD4+ count dropped below 200 or they developed AIDS (the late-treatment group). After approximately two years, 28 patients in the early-treatment group developed AIDS, compared to 48 patients in the late-treatment group. Twenty-three patients in the early-treatment group died, compared to 20 patients in the late-treatment group. Patients in the early-treatment group lived an average of 16 months after the onset of AIDS, compared to an average survival of 19 months among patients in the late-treatment group.

Health aspects

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Long-term follow-up of symptomatic HIV-infected patients originally randomized to early versus later zidovudine treatment: report of a Veterans Affairs cooperative study

Article Abstract:

Early treatment of HIV infection with zidovudine may delay the development of AIDS but have no greater impact on survival than late treatment. Of 338 HIV-infected people, 170 received zidovudine when they had symptoms of HIV infection and a CD4 count between 200 and 500, while 168 received the drug after they had an AIDS-defining symptom or a CD4 count below 200. During three years of follow-up, 67 people in the early treatment group and 85 people in the late treatment group developed AIDS. In the early treatment group there were 74 deaths and in the late treatment group there were 73 deaths. Factors that increased the risk of death following AIDS diagnosis included homosexual activities, lymphoma, CD4 counts below 100, and prolonged zidovudine therapy without other antiviral drugs. The risk of death decreased if another antiviral drug was administered.

Dosage and administration

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Changes in plasma HIV-1 RNA and CD4+ lymphocyte counts and the risk of progression to AIDS

Article Abstract:

Changes in HIV ribonucleic acid (RNA) in the blood and CD4+ lymphocytes may be valid predictors of HIV progression to AIDS. After antiretroviral therapy, blood concentrations of HIV-1 RNA tend to fall sharply. Researchers examined the progression to AIDS among 129 HIV patients who took zidovudine immediately after an initial CD4+ count of 500 or less. A second group of 141 HIV patients did not receive zidovudine until CD4+ counts fell below 200. Thirty-four patients in the prompt treatment group progressed to AIDS, whereas 57 patients who received therapy later developed AIDS. Blood HIV RNA decreases of 75% predicted the absence of AIDS best, followed by a weaker indicator, a 10% increase in CD4+ counts. These physiological markers may indicate the effect of zidovudine and other antiviral drugs.

Measurement, Physiological aspects, Development and progression, RNA, AIDS (Disease), CD4 lymphocytes

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