Zidovudine: does it work for everyone?

Article Abstract:

About 45 percent of reported AIDS cases have occurred in racial and ethnic minorities, such as blacks, Hispanics, Asian-Pacific islanders, native Americans, or Alaskan native people. These AIDS patients represent those in the later stages of human immunodeficiency virus (HIV) disease. This trend of increased proportion of non-white patients also appears to be true of asymptomatic HIV-infected individuals. The incidence of AIDS is also rising among women. The representation of minorities (non-whites and women) in the clinical trials of anti-HIV drugs is low; these trials have been composed mainly of homosexual white men. In early 1991, the media reported preliminary information that one of the anti-HIV drugs, zidovudine, may be less effective in blacks than in whites. In the November 20, 1991 issue of the Journal of the American Medical Association, two studies are reported that suggest that this is not true. Both studies reported no significant difference in effectiveness of zidovudine among the different racial groups. Neither of these studies were cross-race or cross-sex comparisons; subgroups from a larger patient population were used, and conclusions from secondary analyses must be viewed cautiously. There should be more direct attention given to these questions. Researchers need to find new ways to insure that these under-represented groups are included in clinical trials. When new anti-HIV drugs are being tested, their usefulness should be tested not just on the patients who are the easiest to recruit and retain in the trial. The study population should include representatives from all groups of patients affected by the disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Editorial, Minorities

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Effects of zidovudine therapy in minority and other subpopulations with early HIV infection

Article Abstract:

It has recently been shown that zidovudine (formerly called AZT) provides benefits to people with early human immunodeficiency virus (HIV) disease and who are either without symptoms or have only mild symptoms. Although the rates of newly acquired HIV infections appear to have stabilized for American homosexuals, they have continued to increase in American blacks, Hispanics, women, and intravenous (IV) drug users. A study was undertaken to determine if the previously noted benefits of zidovudine treatment also apply to blacks, Hispanics, women, and IV drug users. There were 2,048 patients with early HIV infection who were analyzed; among these subjects, there were 155 blacks, 190 Hispanics, 144 women, and 221 IV drug users. The rate of progression of HIV disease to acquired immune deficiency syndrome (AIDS) was significantly lower among those given zidovudine therapy than those given placebo among the blacks, whites, Hispanics, non-Hispanics, men, and non-IV drug abusers. For women and IV drug users, there was no statistically significant difference in disease progression between the two treatment groups. The relative risks for women and IV drug users were similar to those for men and non-IV drug abusers. It is concluded that the beneficial effect of zidovudine in delaying the progression of HIV infection to AIDS, as established in larger studies, also applies to minority subpopulations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Development and progression

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Health status and function with zidovudine or zalcitabine as initial therapy for AIDS: a randomized controlled trial

Article Abstract:

Zidovudine may be more effective than zalcitabine in preserving AIDS patients' functional and health statuses. Researchers surveyed and administered antiretroviral therapy to 338 HIV-infected people who were symptomatic or had a history of pneumocystis carinii pneumonia. One group of 174 patients received .75 milligrams (mg) of oral zalcitabine every eight hours and a placebo resembling zidovudine every four hours. The other patients received 100 or 200 mg of zidovudine every four hours and a placebo resembling zalcitabine every eight hours. Patients who took zalcitabine were more likely to require hospitalization and to undergo invasive medical procedures than zidovudine recipients. Patients treated with zalcitabine had 41% more symptoms that inhibited their activities and required 50% more days of bed rest than zidovudine-treated patients. Zalcitabine recipients had significantly poorer health status than zidovudine recipients during the first 84 weeks of the study.

Usage, Health status indicators, Zalcitabine

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