Long-term safety and efficacy of zidovudine in patients with advanced human immunodeficiency virus disease

Article Abstract:

Results are presented from an ongoing study of the safety and effectiveness of zidovudine (azidothymidine), the only drug currently licensed by the Food and Drug Administration for treating human immunodeficiency virus type 1 (HIV-1) infection, which causes AIDS. The study, started in 1987, involved 886 patients at 12 clinical sites. Eligible patients had AIDS or AIDS-related complex (certain symptoms in a patient who has tested positive for HIV antibodies) and levels of CD4-positive T lymphocytes (a type of white blood cell) that were below 250 per microliter (a measure of the extent to which the immune system has been compromised by the disease). Most patients received 200 milligrams of zidovudine six times daily as an initial dose, and then 100 milligrams six times daily. Thirty-two percent of the patients died during the follow-up period; 12-month survival was 83 percent and 18-month survival was 67 percent. Patients who died early were more likely to have a CD4-positive T cell count of less than 150 per microliter, a hematocrit (reflecting the number of red blood cells) of less than 35, low or moderate functional status, and 60 days or more between the time of diagnosis and the time when zidovudine treatment began. Age, sex, race, weight, mode of HIV transmission, and certain other variables were not associated with survival. Anemia (insufficient number, or impaired function, of red blood cells) was the most common reason zidovudine therapy was temporarily interrupted, and serious anemia was the condition most often associated with shorter survival. Since a control group not being treated with zidovudine was not included, it cannot be said with certainty that zidovudine led to lowering of the hematocrit, but this is likely; however, even patients with serious anemia lived longer when they took zidovudine. This detailed, long-term study shows that zidovudine is tolerated for up to two years by most patients with advanced disease due to HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Zidovudine

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Natural history of opportunistic disease in an HIV-infected urban clinical cohort

Article Abstract:

HIV-infected people may not develop opportunistic infections until their immune systems are severely damaged. This may be in contrast to the early years of the HIV epidemic. Researchers evaluated 1,246 HIV-infected patients at an urban HIV clinic who had CD4+ cell counts of 300 or less. Rates of infection with Pneumocystic carinii pneumonia, the most common HIV-related opportunistic infection, and of Kaposi sarcoma, the most common HIV-related cancer, decreased as compared to rates of infection in the early 1980s. Rates of cryptococcal meningitis, herpes zoster, and secondary P. carinii pneumonia decreased in the last five years. The use of the drugs fluconazole, rifabutin, and trimethoprim-sulfamethoxazole may be associated with the drop in disease rates.

Complications and side effects, Demographic aspects, Opportunistic infections

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Adherence to antiretroviral and pneumocystis prophylaxis in HIV disease

Article Abstract:

HIV patients may be poorly compliant with drug treatment regimens, particularly when the dosing schedule is complex. Researchers surveyed 244 HIV patients treated at an urban HIV clinic. Only 60% of patients reported 80% or better compliance with antiretroviral medication therapy, and only 49% reported similar compliance with medication to prevent Pneumocystis pneumonia. Patients were more likely to comply with treatment when required to take antiviral medication two or fewer times each day. Patients who believed they could follow the instructions were more likely to do so.

Health aspects, Surveys, Drug therapy, Patient compliance, HIV patients

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