Early versus delayed zidovudine in the management of HIV infection
The controversy surrounding the use of early versus delayed zidovudine therapy has created a contentious debate among clinical investigators, practitioners and their patients. The theoretical basis for antiretroviral therapy derives from the importance of chronic viral replication, especially in lymphoid tissues, throughout the course of HIV infection. Zidovudine has been evaluated in patients with early to middle stages of HIV infection in eight randomised double-blind placebo-controlled trials. Although the trials differ in length of follow-up, zidovudine dosage and endpoint definitions, five conclusions are apparent from a review of their results: early zidovudine does not improve length of survival over delayed zidovudine, early zidovudine results in a transient (one to two years) delay in progression to AIDS, early zidovudine results in a delay in the onset of symptomatic HIV disease, early zidovudine alters surrogate markers for HIV in a favourable direction, and early zidovudine is well tolerated. These clinical benefits of early zidovudine prescription support its use in clinical practice, especially in conjunction with improving strategies of clinical management for patients who deteriorate after receiving early zidovudine. Ultimately combinations of antiretroviral agents may prove most clinically effective and control the emergence of drug resistant isolates from a large viral reservoir in lymphoid tissues. 1994 © Ashley Publications Ltd.
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