AIDS TREATMENT NEWS Issue #183, September 17, 1993
John S. James
This trial included 993 volunteers, who were randomly assigned to take AZT or placebo for three years. All were HIV positive and asymptomatic, with T-helper counts above 400, when they started.
Why is this result different from that of the Concorde study (the second major AZT trial, and the one which accounted for much of the pessimism coming out of the recent International Conference on AIDS in Berlin), which found only a small and temporary benefit from AZT? No one knows for sure, but a major difference is that the patients entering the European- Australian study started at an earlier stage in disease progression (median T-helper count was about 650). Also, there were a number of other differences between the trials, such as the exact definition of what was counted as disease progression.
When the negative results of the Concorde AZT study came out, most physicians did not change their prescribing practices greatly; instead they chose to wait for more information. Some of the press reports exaggerated the pessimism, however, probably leading some patients to be too quick to drop antiretroviral treatment. It is clear that AZT, ddI, ddC, and probably d4T are poor anti-HIV drugs. But for many patients, they seem to be clearly better than nothing.
And the European-Australian study suggests that early treatment is better than late. "The implication is that most patients with HIV infection should be treated, but the benefit may be greatest if therapy is begun when CD4 cell counts are over 300 to 400 per cubic millimeter," according to an accompanying editorial.
[Cooper DA, Gatell JM, Kroon S, and others. Zidovudine in persons with asymptomatic HIV infection and CD4+ cell counts greater than 400 per cubic millimeter. THE NEW ENGLAND JOURNAL OF MEDICINE. July 29, 1993; volume 329, number 5, pages 297-303. Also see editorial on pages 351-352 of the same issue.]
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