A Comparison of Zidovudine, Didanosine, Zalcitabine and No Antiretroviral Therapy in Patients with Advanced HIV Disease

Abstract

Three nucleoside analogues, zidovudine (AZT), didanosine (ddI), and zalcitabine (ddC), are approved for use in the treatment of patients with HIV infection. This retrospective study compares the 3 drugs and examines the overall utility of antiretroviral therapy by way of comparisons to a no treatment (No Rx) group in patients with advanced HIV disease. Patients with advanced HIV disease were enrolled in didanosine (August 1989-December 1990) or zalcitabine (October 1990-February 1992) expanded access programmes; continued on zidovudine treatment despite fulfilling criteria for zidovudine failure or intolerance; or maintained on no antiretroviral treatment. Statistical analysis revealed that patients on nucleoside analogue therapy had fewer opportunistic infections (P = 0.001) than those who received no antiretroviral treatment. The Kaplan-Meier 12-month estimate of survival was significantly longer among patients who switched from zidovudine to zalcitabine but not among patients who switched to didanosine, when compared to the other 2 groups (P = 0.05).

High-Performance Liquid Chromatographic Analysis of 2′-Fluoro-2′,3′-dideoxyadenosine and 2′-Fluoro-2′,3′-dideoxyinosine in Dog Plasma and Urine

“…[1][2][3] In general, the in vitro activity of ddN analogs is attributed to either a competitive inhibition of the viral reverse transcriptase 4 or a termination of DNA proliferation by blockade of the 3′-hydroxy group. 5 2′-Fluoro-2′,3′-dideoxyadenosine (FddA) is a fluoro analog of ddN.…”

Peripheral neuropathy: zalcitabine reassessed

“…In addition to suffering from advanced disease, it is also likely that many of the patients participating in these trials will have had PN at study baseline. In one study, 4% of participants were known to have PN prior to treatment with zalcitabine 13 . Such patients would be excluded from studies of zalcitabine today.…”

“…The lowest incidence of PN during treatment with zalcitabine was seen in the Pisces study, the largest study of antiretroviral therapy reported to date 28 (Stellbrink et al, manuscript in preparation). This assessed the ef® cacy and safety of triple therapy with zalcitabine, saquinavir hard gel capsules (Invirase 1 ; F. Hoffmann± La Roche Ltd) and zidovudine (Retrovir 1 ; GlaxoWellcome) in 3485 patients who had received only minimal prior antiretroviral therapy (no more than 16 weeks of CPCRA 002 12 29.1 (all intensities) Patients with advanced HIV infection intolerant of or failing treatment with zidovudine Median baseline CD4 cell count: 34 cells/mm 3 Torres et al 13 46 (all intensities) AIDS/ARC patients intolerant of or failing treatment with zidovudine Mean baseline CD4 cell count: 57 cells/mm 3…”