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M94A2811.TXT
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1994-10-25
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Document 2811
DOCN M94A2811
TI Acyclovir/zidovudine combination therapy and AIDS survival. Multicenter
AIDS Cohort Study.
DT 9412
AU Stein DS; Graham NM; Park LP; Hoover DR; Phair JP; Detels R; Ho M; Saah
AJ; Johns Hopkins University, Baltimore, MD 21205.
SO Int Conf AIDS. 1994 Aug 7-12;10(1):22 (abstract no. 060B). Unique
Identifier : AIDSLINE ICA10/94369764
AB OBJECTIVE: To examine the effect of acyclovir use on disease progression
and survival in zidovudine treated HIV + individuals. METHODS:
Prospective cohort study of gay and bisexual men seen semiannually.
Intent to treat Cox models were fit to determine the relationship
between use of acyclovir (modelled as a time dependent covariate) and
disease progression controlling for baseline (hemoglobin, platelets) and
time dependent (CD4 count, HIV symptoms, PCP prophylaxis, herpes
episodes, and other antiretroviral therapy) prognostic variables.
AIDS-free and survival times were calculated from the first use of
zidovudine (n = 786). Acyclovir use was defined as acyclovir-any (n =
488; acyclovir use for herpes or HIV) or acyclovir-HIV, (n = 242; HIV
indication only: postulated to have higher dose, less intermittent use).
RESULTS: Acyclovir was not associated with effects on progression to
AIDS or CMV. Acyclovir-any was associated with a 26% decrease in risk of
death (RH = 0.74, P = 0.07) and acyclovir-HIV was associated with a 36%
decrease in risk of death (RH = 0.64, P = 0.01). Greater constancy, but
not dose of acyclovir use was related to better survival. Acyclovir-any
and acyclovir-HIV were significantly associated with a 44% decreased
probability of death if used post-AIDS (P = 0.007 and P = 0.005
respectively), but not pre-AIDS. Landmark analysis, using multivariate
Cox models, gave estimated median survival times of 1018, 745 and 544
days for men with CD4 count < 50 or AIDS comparing those who started
acyclovir at or prior, either never or after, and never, respectively
after the landmark point. CONCLUSIONS: Consistent use of acyclovir in a
dose sufficient to suppress herpetic recurrences (600-800 mg/d) may have
a significant impact on prolonging survival.
DE Acquired Immunodeficiency Syndrome/*DRUG THERAPY/MORTALITY
Acyclovir/*ADMINISTRATION & DOSAGE Cohort Studies Drug Therapy,
Combination Herpesviridae Infections/PREVENTION & CONTROL Human HIV
Seropositivity/*DRUG THERAPY Leukocyte Count Male Multivariate
Analysis Prospective Studies Survival Analysis T4 Lymphocytes
Zidovudine/*ADMINISTRATION & DOSAGE MEETING ABSTRACT
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).