The safety and efficacy of zidovudine (AZT) in the treatment of subjects with mildly symptomatic human immunodeficiency virus type 1 (HIV) infection. A double-blind, placebo-controlled trial. The AIDS Clinical Trials Group.
OBJECTIVE
To evaluate the efficacy and safety of zidovudine early in the treatment of human immunodeficiency virus type 1 (HIV) infection.


METHODS
A double-blind, randomized, placebo-controlled trial with subject stratification by pretreatment CD4 T lymphocyte counts.


METHODS
Multicenter trial at AIDS Clinical Trial units.


METHODS
Seven hundred eleven subjects with mildly symptomatic HIV infection.


METHODS
Three hundred fifty-one subjects were assigned to placebo and 360 to zidovudine, 200 mg orally every 4 hours. The median duration of follow-up was 11 months.


RESULTS
Fifty-one subjects developed the acquired immunodeficiency syndrome (AIDS), advanced AIDS-related complex, or death as a first critical event. For the stratum of subjects with more than 200 but less than 500 CD4 T lymphocytes/mm3 before treatment, 34 events occurred in placebo recipients and 12 in zidovudine recipients (P = 0.0002; relative risk [RR] estimate, 3.23 [95% CI, 1.67 to 6.24]). For the stratum of subjects with 500 to 799 CD4 T lymphocytes/mm3 before treatment, 2 events occurred in placebo recipients and 3 in zidovudine recipients. Candidiasis at study entry independently increased the risk for having an event (P = 0.005; RR estimate, 2.3 [95% CI, 1.29 to 4.12]); HIV antigenemia at study entry also increased this risk (P = 0.01; RR estimate, 2.1 [95% CI, 1.2 to 3.8]). Significant differences between the treatment groups in CD4 T-lymphocyte counts occurred in subjects with more than 200 but less than 500 CD4 T lymphocytes/mm3 after 4 weeks of therapy (P = 0.002). Differences persisted through week 52. Less prominent changes occurred in subjects with 500 or more CD4 T lymphocytes/mm3. Serum levels of HIV antigen decreased significantly in zidovudine recipients. Serious anemia and neutropenia occurred in 5% and 4% of zidovudine recipients, respectively, and in 0% and 1% of placebo recipients, respectively.


CONCLUSIONS
Zidovudine delayed progression of HIV disease and produced little toxicity in subjects with mildly symptomatic HIV disease and less than 500 CD4 T lymphocytes/mm3.
Fischl
M A
MA
University of Miami School of Medicine, Department of Medicine, FL 33101.
Richman
D D
DD
Hansen
N
N
Collier
A C
AC
Carey
J T
JT
Para
M F
MF
Hardy
W D
WD
Dolin
R
R
Powderly
W G
WG
Allan
J D
JD
D000386:AIDS-Related Complex / Q000188:drug therapy / Q000453:epidemiology; D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology; D000328:Adult; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects; D003627:Data Interpretation, Statistical; D004311:Double-Blind Method; D005260:Female; D015488:HIV Antigens / Q000378:metabolism; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D015497:HIV-1 / Q000276:immunology; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D007958:Leukocyte Count / Q000187:drug effects; D008297:Male; D015337:Multicenter Studies as Topic; D009894:Opportunistic Infections / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D015215:Zidovudine / Q000009:adverse effects / Q000627:therapeutic use*
D015488:HIV Antigens; D015215:Zidovudine