Being Alive; March 1992
presented by Mark Katz MD and reported by Jim Stoecker

The finding that made the newspapers concerned the survival rates of the two groups. Researchers compared the three year survival rates of the early and late treatment groups and found no statistical difference. Twenty-three of the 170 in the early group had died, while 20 of the 168 in the late group were dead. Researchers did note that the early treatment group was slower in progressing to AIDS than the late treatment group. Once the early group did get AIDS, however, they seemed to have a more virulent bout, a more stormy, downhill course.

Hot on the heels of the VA study came a study out of Europe, sponsored, it should be noted, by Burroughs-Wellcome, the manufacturers of AZT. (There just might be more than coincidence in the timing of the study release.) This study looked at groups with CD4 counts in the 400-500 range and in the 500-750 range. Researchers found a slower progression of HIV disease in those taking AZT than those not on an antiviral. Progression was defined as either the development of AIDS-defining symptoms or a drop in CD4 count to below 350. Of the over 400 people in the study, 18% of those not on AZT progressed, while only 9% of those on AZT progressed. This study found for the first time that AZT might be beneficially used even earlier than previously thought. A similar study is now going on in the US and the American data should be released later this year.

What does one conclude from these studies? Clearly, the issue of when to begin antiviral therapy is not yet a closed one. We still do not know the long term effects of AZT use.

What we do know is that HIV is an ongoing infection that tends to progress over time. Why not intervene when the viral burden is lower and do our best to contain the virus at that point? On the other hand, AZT does do things to the cells other than inhibit the reverse transcriptase phase of HIV in CD4. The drug has significant toxicities and could possibly have a long term deleterious effect. Why risk these side effects for what may be limited efficacy?

The final word is not in. Meanwhile, however, I support earlier, more aggressive antiviral therapy. It appears at this time that a majority of HIV+ people are helped by AZT and that the benefits outweigh the risks.
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