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M9480647.TXT
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1994-08-20
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Document 0647
DOCN M9480647
TI Zidovudine twice daily in asymptomatic subjects with HIV infection and a
high risk of progression to AIDS: a randomized, double-blind
placebo-controlled study. The European-Australian Collaborative Group
(Study 017).
DT 9410
AU Mulder JW; Cooper DA; Mathiesen L; Sandstrom E; Clumeck N; Gatell JM;
French M; Donovan B; Gray F; Yeo JM; et al; Slotervaatziekenhuis,
Department of Internal Medicine, Amsterdam,; The Netherlands.
SO AIDS. 1994 Mar;8(3):313-21. Unique Identifier : AIDSLINE MED/94304551
AB OBJECTIVE: To evaluate the efficacy of zidovudine given twice daily in
subjects with asymptomatic HIV-1 infection and a high risk of
progression to AIDS. DESIGN: Randomized, double-blind placebo-controlled
trial. SETTING: Multicentre study in five European countries and
Australia. PATIENTS: Asymptomatic subjects (n = 329) with CD4 cell
counts between 200 and 400 x 10(6)/l, or if > 400 x 10(6)/l, subjects
with HIV p24 antigenaemia (> 10 pg/ml). INTERVENTION: Patients were
randomly assigned to receive zidovudine 500 mg or placebo twice daily
for 104 weeks, following a 250 mg four times daily dose regimen for the
first 4 weeks. MAIN OUTCOME MEASURES: The primary end-point was the
development of AIDS or severe AIDS-related complex (ARC). Before
unblinding the study other end-points were defined: the development of
Centers for Disease Control and Prevention (CDC) group IV disease (AIDS,
severe ARC and other CDC stage IV disease) and the development of
symptomatic HIV disease (AIDS, severe ARC, other CDC stage IV disease
and minor HIV disease). Changes in CD4+ cell counts, p24 antigenaemia
and toxicity were also reviewed. RESULTS: Median treatment duration was
57 weeks for the placebo and 60 weeks for the zidovudine group,
respectively. Progression to AIDS or severe ARC occurred in 17 placebo
and 12 zidovudine recipients (log-rank P = 0.26). However, in the first
of the 2 study years the rate of progression to AIDS or severe ARC was
significantly higher in the placebo than in the zidovudine group.
Zidovudine delayed progression to symptomatic HIV disease (P = 0.01); a
trend in a delay in progression to CDC stage IV disease was observed (P
= 0.08). Zidovudine recipients maintained CD4+ cell counts at or above
baseline levels for longer than placebo recipients (P = 0.04). HIV
p24-antigen levels decreased in the zidovudine group and returned to
pretreatment levels by week 36. Substantial toxicity was not observed.
CONCLUSIONS: Zidovudine twice daily is effective in delaying progression
to symptomatic HIV disease in high-risk, asymptomatic HIV-infected
subjects. Modified definitions of clinical end-points may be useful for
evaluating Phase III trials in comparable patient groups in the light of
changes in the definition of AIDS and the increasing use of primary
prophylaxis against opportunistic infections.
DE Acquired Immunodeficiency Syndrome/PREVENTION & CONTROL AIDS-Related
Complex/PREVENTION & CONTROL Double-Blind Method Europe Female Human
HIV Core Protein p24/BLOOD HIV Infections/BLOOD/*DRUG
THERAPY/MICROBIOLOGY *HIV-1 Leukocyte Count Male Patient Compliance
Risk Factors Safety Time Factors T4 Lymphocytes
Zidovudine/*ADMINISTRATION & DOSAGE/ADVERSE EFFECTS CLINICAL TRIAL
JOURNAL ARTICLE MULTICENTER STUDY RANDOMIZED CONTROLLED TRIAL
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).