Considerations in the initiation of antiretroviral therapy.
Int Conf AIDS 1994 Aug 7-12; 10:4 (abstract no. PS17) Volberding PA; University of California AIDS Program, San Francisco General Hospital.
The optimal point to initiate antiretroviral therapy in HIV disease continues to generate controversy. Used in symptomatic HIV disease, zidovudine and other nucleoside analogues has reduced clinical progression, and prolonged survival. In asymptomatic stages of HIV infection, however, where the risk of progression or death are much lower, clinical benefits of antiretroviral therapy are less striking. This is the case despite a clearer rationale for such treatment, based on knowledge of the pathogenesis of HIV disease. Using more stringent definitions of progression (AIDS or death), zidovudine is active in those with CD4 cells below 500/mm3. Survival, however, is not additionally prolonged over that achieved with a delayed use of this drug. In those with CD4 cells above 500/mm3, where the risk of clinical progression to AIDS or death is extremely slight, zidovudine has not shown clinical benefit in prospective clinical trials. The resolution of this controversy awaits the development of more effective and durable treatment strategies, but may be aided by virologic markers of response to therapy if clinical validation of these tests is successful.
Keywords: AEGIS, Zidovudine, HIV Infections, Acquired Immunodeficiency Syndrome, Anti-HIV Agents, Drug Therapy, Combination, Antiretroviral Therapy, Highly Active, Clinical Trials, therapy, drug therapy, ICA10 940807
PS17
