Zidovudine therapy in an inner city population

Article Abstract:

The majority of the studies on the effectiveness and safety of zidovudine (AZT) have been conducted using homosexual men who were infected with human immunodeficiency virus, type 1 (HIV-1). A study was conducted to analyze the use of zidovudine among patients with HIV-1 infection from an inner-city HIV clinic in New York City, where the patients included intravenous drug users, minorities and women. There were 99 patients, of whom 75 percent were males, 92 percent were minorities and 59 percent used intravenous drugs. Seventy-three percent had AIDS and 27 percent had a syndrome known as AIDS-related complex (ARC). Eighty-eight percent of the patients were compliant with the therapy, but 57 percent had at least one drug reaction. The adverse reactions included a reduction in the number of white or red blood cells, nausea and headache. Dosage reductions were required for 44 percent, and 13 percent had to stop taking the drug altogether. Opportunistic infections or HIV-related malignancies occurred in 18 percent of the patients who were on zidovudine for at least four weeks. Nine percent (seven out of 82) of the patients who were on zidovudine for four weeks died, compared with 53 percent (9 out of 17) of the patients who did not complete the therapy. It is concluded that patients in inner-city AIDS clinics, including intravenous drug users, whose lives are often chaotic, and minorities, for whom cultural differences and low socioeconomic status often interfere with health care, could comply with zidovudine treatment and that the drug can be tolerated by these individuals. The success of the inner-city clinic is thought to be related to factors such as easy accessibility of care, location in a familiar neighborhood, and the social support provided by the clinic. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Women, Patient compliance, Minorities, Drug addicts, Drug abusers, Drug use, Inner cities

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The effect of acetaminophen on zidovudine metabolism in HIV-infected patients

Article Abstract:

In some clinical trials, administering the analgesic acetaminophen to AIDS patients taking zidovudine has been implicated with serious bone marrow toxicity. However, it is uncertain that the effect is a result of acetaminophen, or if the conditions which led to the use of acetaminophen are also those which lead to bone marrow toxicity. Acetaminophen became suspect because it is eliminated from the body in the same manner as zidovudine; both are metabolized to the glucuronidated form and then excreted. It is thought that the acetaminophen would compete with the zidovudine for glucuronidation; more toxic zidovudine would presumably continue to circulate in the bloodstream. While plausible, hard evidence has not been presented to support this idea. Nevertheless, recommendations against the use of acetaminophen in patients taking zidovudine have been generally accepted. To better examine this effect, four patients taking zidovudine were enlisted into a study on the effect of acetaminophen. The patients were given 650 mg of acetaminophen every six hours, and an additional dose one half hour prior to receiving the zidovudine. Blood samples were taken every 15 minutes for the first hour, then every half hour for the next three. High-pressure liquid chromatography (HPLC) was used to determine the concentration of zidovudine and glucuronidated zidovudine. Contrary to the prevailing notion, the blood levels of zidovudine sustained by the patients after acetaminophen administration were the same as those measured without acetaminophen. The results suggest that the recommendation against the use of acetaminophen for analgesia and fever reduction in patients taking zidovudine should be reconsidered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Acetaminophen, AIDS virus carriers, HIV carriers

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HIV-1 proviral copy number in blood mononuclear cells from AIDS patients on zidovudine therapy

Article Abstract:

Zidovudine (ZDV) prolongs the development of AIDS in individuals who are infected with HIV (human immunodeficiency virus). Because ZDV blocks replication of the virus, it is assumed that the levels of virus in individuals infected with HIV would decrease. However, little research has been done testing the effect of ZDV on the virus levels in HIV-infected individuals. The concentrations of HIV in mononuclear white blood cells, which are known to contain HIV, were measured in six infected individuals during 5 to 14 months of treatment with ZDV. The levels of virus were measured with the polymerase chain reaction, which amplifies the concentration of virus to levels that can be studied. The levels of HIV did not change in five of the individuals during the treatment period. In one individual, the virus levels actually increased, then remained stable. It is possible that ZDV inhibits infection of new cells but does not affect cells that are already infected. To cure AIDS, therapies must be developed that will kill HIV-infected cells and prevent infection of new cells. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, HIV infection, HIV infections

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