Natural history of advanced HIV disease in patients treated with zidovudine

R. D. Moore, J. Keruly, D. D. Richman, T. Creagh-Kirk, R. E. Chaisson

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To describe the natural history of advanced HIV disease in patients treated with zidovudine. Design: Longitudinal, observational study. Setting: Twelve academic and community-based sites. Patients, participants: Eight hundred and sixty-three patients with AIDS or AIDS-related complex (ARC) with a CD4+lymphocyte count <250 x 106/l, who first received zidovudine between 15 April 1987 and 14 April 1988. Main outcome measures: Survival, progression to AIDS and first development of specific opportunistic illness. Results: Median survival after initiation of zidovudine therapy ranged from > 900 days in patients with a baseline CD4+ lymphocyte count ≥50 106/l to 560 days in patients with a CD4+ lymphocyte count <50 106/l. Other factors associated significantly with poorer survival were diagnosis of AIDS (versus ARC), baseline age ≥40 years, hematocrit < 35%, and diminished functional status. In patients with ARC at enrollment, median time of progression to AIDS ranged from 810 days in patients with a CD4+ lymphocyte count ≥150 x 106/l to 310 days in patients with a CD4+ lymphocyte count < 50 x 106/l. Rates of development of specific opportunistic infections or neoplasms and HIV encephalopathy were determined for different baseline CD4+ lymphocyte count ranges. Myelosuppression was significantly more common in patients with CD4+ lymphocyte counts ≥100 x 106/l. Sixty-five per cent of patients with a CD4+ lymphocyte count ≥100 x 106/l and 51% with a CD4+ lymphocyte count < 100 x 106/l continued to receive zidovudine 2 years after starting therapy. Conclusions: We describe the natural history of a cohort of patients treated with zidovudine for advanced HIV disease. These CD4 + lymphocyte count-stratified estimates of disease progression should provide prognostic information useful in the clinical management of advanced disease and the design of future studies.

Original languageEnglish (US)
Pages (from-to)671-677
Number of pages7
JournalAIDS
Volume6
Issue number7
StatePublished - Jan 1 1992

Keywords

  • Epidemiology
  • Natural history
  • Opportunistic infection
  • Zidovudine

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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