Newsday - April 16, 1992
Laurie Garrett
People who take the antiviral drug AZT in the early stages of infection with the virus that causes AIDS live nearly two years longer than those who never take the drug, according to a study to be released today.
The finding contradicts an earlier Veterans Affairs study that found no survival benefit with long-term use of azidothymidine, or AZT.
It comes amid reports that two other drugs that attack the human immunodeficiency virus have proven effective in delaying the onset of AIDS, and, in the case of one, prolonging life more than AZT.
AZT has been used to fight HIV since 1986, even while the drug's effectiveness was being studied. The latest study, published in today's New England Journal of Medicine, concludes that the drug both delays the onset of AIDS when taken by people who are in early stages of HIV infection and delays death in people with AIDS.
A second study, released this week by the National Institute of Allergy and Infectious Diseases, found that the drug ddI (dideoxyinosine) extends life expectancy further than AZT and significantly boosts people's immune responses. Participants in the study all took AZT first for some weeks, but about half switched to ddI either because they couldn't tolerate the AZT-generated anemia or because they believed they would get greater benefit from the newer drug. No specific numbers on the survival benefit of ddI were provided.
"The good news is these drugs give you the option of surviving long enough to be around for new therapies, when they come along," Johns Hopkins School of Medicine's Dr. Neil Graham said in an interview. Graham was one of the researchers involved in the AZT study, which, unlike most previous AZT studies, was not underwritten by the drug's manufacturer, Burroughs Wellcome. More than 2,500 gay men took part.
The participants in the AZT study are members of the Multicenter AIDS Cohort Study, which was established in 1984 by Johns Hopkins researchers. Over that time, the men have been carefully studied, their drug treatment choices followed and health monitored. Because AZT was viewed with strong suspicion in the gay community in the late 1980s, many members of the Multicenter group chose not to take the drug. That allowed scientists to compare the survival times of AZT users and non-users.
"AZT is not a cure," the study director, Dr. Sten Vermund of the infectious diseases institute, said. "But if you compare the groups, there were 57 percent fewer deaths among AZT users after six months, and 33 percent fewer deaths after two years."
The study also showed that men who took AZT and drugs to prevent a type of parasitic pneumonia that plagues AIDS patients lived still longer.
The institute also released results this week of a study that compared AZT to ddI in 913 HIV-infected people. They found the two drugs of equal benefit if taken after a person already had AIDS. But when taken by people in early stages of HIV infection, ddI delayed AIDS onset longer than did AZT.
Next week, federal researchers will release findings that show still another drug, ddC (dideoxycytidine), compares very favorably to AZT. Next week, the Food and Drug Administration will hear evidence, manufacturers and activists said.
Because few people with HIV take just one drug at a time, "it's very hard to get a handle on how much AZT is extending life," Vermund said.
People who started therapy in recent years are living longer without full AIDS than were their counterparts six or seven years ago, Vermund said.
But AZT and ddI skeptics remain. The drugs have serious side effects, including life-threatening anemia and pancreas damage. And a recent VA study found that AZT use did not increase survivability.
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