A pilot study of low-dose zidovudine in human immunodeficiency virus infection

Article Abstract:

Zidovudine is the only drug that has been approved in the US for the treatment of AIDS patients and individuals who are infected with human immunodeficiency virus (HIV, which causes AIDS). Some HIV-infected individuals have not yet developed full-blown AIDS, but they exhibit some symptoms of the disease and are, therefore, considered to have ARC or AIDS-related complex. The present study examines the clinical value of using various doses of zidovudine with and without acyclovir, an antiviral drug, to treat patients with ARC. Acyclovir has no known activity against HIV, but is effective against herpes virus. The study was undertaken, in part, because others have suggested that the combination of zidovudine and acyclovir may be effective in slowing the progression of ARC to AIDS. Sixty-seven HIV-infected individuals who had CD4-T lymphocyte counts in the range of 200 to 500 cells per cubic millimeter of blood, and mild-to-severe ARC symptoms were included in the study. They were assigned to one of 6 different zidovudine treatment groups and received either 300 milligrams (mg), 600 mg, or 1,500 mg of zidovudine per day alone or in combination with 4.8 grams of acyclovir. The patients remained on their first assigned drug regimen for 12 weeks. This was followed by an elective extension that varied greatly in length, and an 8-week cross-over period during which the zidovudine dose was changed either from highest to lowest, or from the lower two dose levels to the highest. The fatigue levels and physical performance of the patients on the two lowest doses were significantly better than those of the patients treated with the standard zidovudine dose (1,500 mg per day). The lower-dose patients also experienced fewer side effects, gained the most weight, and maintained higher CD4-T lymphocyte counts (a good sign). A significant number of individuals, regardless of their zidovudine dosage showed improvement in the level of viral antigen (a reduction of the protein p24). When ARC patients were crossed-over to the higher dose level their levels of CD4-T lymphocytes and HIV antigen did not change, but they experienced a greater number of the side effects associated with zidovudine. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Measurement, Complications and side effects, Dosage and administration, Acyclovir, T cells, Zidovudine

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Plasma viremia in human immunodeficiency virus infection

Article Abstract:

The human immunodeficiency virus type 1 is the known causative agent of acquired immunodeficiency syndrome (AIDS). The infection can be detected by various means before any symptoms develop; the person is considered seropositive if the virus is detectable in the blood. When symptoms do develop, the infected patient usually passes through a period of incomplete development of the disease called AIDS-related complex, or ARC, before going on to exhibit all the manifestations of AIDS itself. It would be particularly useful to develop a method of objectively detecting the development of the immunodeficiency infection. This study examines the blood of 213 seropositive and 71 seronegative patients for indications of the level of the virus infection. Measurements were made of the frequency of peripheral mononuclear cells that demonstrate viral infection, and the frequency and level (titer) of virus in the patient's blood plasma. The investigators were able to identify virus in 97 percent of all peripheral blood mononuclear cells without regard to the clinical state of the patient or degree of infection. Detectable levels of human immunodeficiency virus were found in 55 percent of patients with symptoms, potentially a marker of considerable significance. The level of HIV in the blood plasma proved to be strongly related to the progression of the disease process, and may be useful in studying the effects of different treatments. However, despite this correlation, there was considerable variation in viral plasma measurements within patient groups at each stage of the illness. A full understanding of the usefulness of the technique will require further study. The authors point out that plasma and other cell-free body fluids should be considered infectious, regardless of the presence of symptoms.

Diagnosis, HIV (Viruses), HIV, Identification and classification, AIDS (Disease)

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Treatment of human immunodeficiency virus infection with saquinavir, zidovudine, and zalcitabine

Article Abstract:

Combined treatment with sasquinavir, zidovudine and zalcitabine appears to be more effective at reducing HIV-1 replication, increasing CD4+ cells counts and decreasing levels of other activation markers in HIV-infected patients than does treatment combining zidovudine with only one of the two other drugs. Sasquinavir is a protease inhibitor, while zidovudine and zalcitabine are nucleosides. A total of 302 people infected with HIV were given either saquinavir in combination with zidovudine and zalcitabine, or zidovudine with either saquinavir or zalcitabine. CD4+ rose temporarily in all three groups, but counts remained higher for a longer period of time in people receiving all three drugs. Those receiving all three drugs also showed greater reductions in plasma HIV and greater decreases in serum neopterin and beta2-microglobulin levels, both of which increase as HIV infection spreads.

Protease inhibitors, Drug therapy, Combination, Combination drug therapy, Nucleoside analogs

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