Zidovudine for early human immunodeficiency virus (HIV) infection: who, when, and how?

Article Abstract:

Acquired immunodeficiency syndrome (AIDS) was originally described in 1981, and human immunodeficiency virus (HIV) was identified as the cause of AIDS in 1983. The only agent that has been effective in altering the process of this rapidly fatal disease is zidovudine (AZT). Previous studies showed that zidovudine prolonged survival, decreased the severity of opportunistic infections, and improved the quality of life among patients with AIDS and AIDS-related complex (ARC). The drug also improved HIV-related nerve disease and thrombocytopenia, a decrease in blood platelets that are important in blood clotting. More recent studies have confirmed that zidovudine delays the progression of HIV infection to AIDS or ARC in persons with less than 500 CD4 per cubic millimeter (mm). CD4 cells are a type of immune cell that is specifically depleted by HIV infection. The combined effects of zidovudine in delaying HIV disease progression and in improving survival and quality of life of AIDS and ARC patients, long-term drug toxicity, and viral resistance to the drug, require further investigation. The need for zidovudine therapy should be assessed by considering the severity of the disease, CD4 counts, and the presence of severe symptoms, such as nerve disease and thrombocytopenia. Although zidovudine therapy is recommended for patients with CD4 counts of less than 200 CD4 cells per cubic mm, it is not clear whether patients with 200 to 500 CD4 cells per cubic mm should receive zidovudine therapy. The most effective and least toxic dose of zidovudine, or an optimal dosage, have not been established. However, doses should be reduced when serious blood disorders develop as a result of treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, HIV infection, HIV infections, Zidovudine, editorial

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Corticosteroids prevent early deterioration in patients with moderately severe pneumocystis carinii pneumonia and the acquired immunodeficiency syndrome (AIDS)

Article Abstract:

Patients with the acquired immunodeficiency syndrome (AIDS) are infected with the human immunodeficiency virus (HIV). As a result of their impaired immune systems, many of these patients become infected with 'opportunistic' microorganisms that do not usually cause disease. The most frequent complication of AIDS is the development of a potentially fatal lung infection called pneumocystis carinii pneumonia. Pneumocystis pneumonia eventually develops in almost 80 percent of HIV-infected patients, and in AIDS patients with respiratory failure, the fatality rate is 20 percent. A number of reports have suggested that the administration of corticosteroids, which decrease inflammation, may decrease the mortality rate of pneumocystis pneumonia and improve the gas-exchanging properties of the lungs. This study assessed the ability of oral corticosteroids to prevent the deterioration seen in AIDS patients with moderately severe pneumocystis pneumonia. Of the 18 patients treated with corticosteroids, only one (6 percent) developed early deterioration, as compared with eight (43 percent) of the 19 patients who received a sugar pill (placebo). All patients who initially received the placebo promptly responded to the corticosteroid treatment. Of those patients on corticosteroid therapy, all exhibited an increase in their tolerance to exercise. This study indicates that corticosteroids are useful in treating AIDS patients with moderately severe pneumocystis pneumonia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Pneumocystis carinii pneumonia, Pneumonia

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Double-blind placebo-controlled pilot trial of acemannan in advanced human immunodeficiency virus disease

Article Abstract:

The drug acemannan does not appear to be beneficial in the treatment of advanced HIV infection. Acemannan can stimulate the production of interleukin-1 and natural killer cells in the laboratory. However, it seemed to have no effect on 30 HIV-infected patients who took 1,600 milligrams daily for 48 weeks, when compared to 33 HIV-infected patients who took a placebo. It did not raise CD4 counts or lower viral p24 antigen levels in the blood. It also did not reduce the frequency of AIDS symptoms or AIDS-related diseases. The drug did not produce any serious side effects.

Evaluation, Immunologic adjuvants, Immunological adjuvants

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