Population-based estimates of zidovudine and aerosol pentamidine use in San Francisco: 1987-1989

Article Abstract:

Zidovudine (also known as ZDV or AZT) is a drug that has been used widely since 1987, when it was first found to be effective in prolonging the life of patients with AIDS. Aerosol pentamidine (AP) is another drug that has been found to be effective against the complications of AIDS - it decreases the rate of recurrence of Pneumocystis carinii pneumonia (PCP), a disease which can be fatal. Despite the help these medications provide, little is known about the extent to which they are used. Data are presented here to shed light on this topic. The data were obtained from the San Francisco Men's Health Study and from the San Francisco General Hospital Cohort; approximately 500 subjects were interviewed regularly from 1987 to 1989. Between 1987 and 1989, the proportion of participants with AIDS using ZDV increased from 36 percent to 68 percent, and there was a similar increase in its use by asymptomatic and symptomatic HIV-infected patients. Use was higher for white subjects as a group than for Hispanic or black subjects, although the numbers of nonwhite subjects were small, so these findings are not necessarily representative. Age group and occupational status were not significant variables. Combined therapy (both ZDV and AP) was used by 43.9 percent of those with AIDS and only 4.8 percent of those with asymptomatic HIV infection. It is suggested that the data may be biased toward overestimating the use of ZDV and AP, because those participating in the study may have been better motivated and informed than the general population. The proportion of patients with AIDS not taking ZDV, about 42 percent, may be explained by side effects, or use of other experimental protocols rather than just failure to use the drug. The low rate of use of AP for prevention of PCP, on the other hand, is alarming and not likely to be due to the use of other drugs that are available, or side effects of AP. Perhaps inadequate health insurance, financial resources, or lack of HIV/AIDS-related education play a role in this trend. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Surveys, HIV infection, HIV infections, Zidovudine, Drug utilization, Drug monitoring, Pentamidine isethionate, Pentamidine

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Incorporation of trial results into clinical practice

Article Abstract:

There are many issues involved in the testing of drugs in clinical trials of AIDS patients. It is important to look at clinical data from around the world, not just from the United States, to learn how various subpopulations react to drugs. The doses and dose intervals will vary, depending on the population that the drug is given to. The criteria for eligibility of participants in clinical trials are being liberalized so that greater numbers and types of subpopulations can be included. However, at the present time, the drugs have not been tested in many subpopulations, which makes choosing the drug and its dose level difficult for physicians when patients are members of these subpopulations. Therefore, there are problems in applying the results from the clinical trials to actual patients. AIDS patients are educated about their disease and the results of clinical trials. It is also difficult for physicians to make decisions on the use of drugs because the clinical data from the trials are not complete. And there are communication problems between pharmaceutical companies and physicians who are treating the patients. It takes time to get information to the physicians about changes in the ways the drugs should be used. Any changes have to be approved by the Food and Drug Administration, which also takes time. It is necessary that guidelines for clinical practice and state-of-the-art reviews are developed, kept up-to-date, and made available to physicians. Another problem lies with insurance companies, which may not pay for drugs not approved for other than standard treatment regimens. With these regimens changing, it also takes time for insurance companies to catch up. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Medicine, Pharmaceutical industry, Reports, Practice, Physicians, Medical professions, Clinical trials, Information services, Communication in medicine, Medical communication

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