Use of zidovudine for drug misusers infected with human immunodeficiency virus

Cowan, Frances M; Jones, Gwyneth; Bingham, J S; Flegg, Peter; MAcCALLUM, L R; Whitelaw, J; Hargreave, D.; Gray, John; Welsby, Philip D; Brettle, R.P.

doi:10.1016/s0163-4453(89)80081-7

Journal of Infection

1989

DOI: 10.1016/s0163-4453(89)80081-7

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Use of zidovudine for drug misusers infected with human immunodeficiency virus

Frances M Cowan¹,

Gwyneth Jones²,

J S Bingham³

et al.

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Cited by 9 publications

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“…[7][8][9][10][11][12][13][14][15] To date, numerous forms of nonadherence have been documented, including modification of the prescribed dosage levels, polypharmacy, and self-termination. [16][17][18] Certain characteristics of ZDV and the ZDV regimen may actually promote nonadherence. The drug causes numerous side effects, which range from the merely discomforting (e.g., headache, nausea, bloating, vomiting, and dyspepsia), 1,2,12 to the outright toxic (e.g., neutropenia, hematopoietic toxicity, and anemia); it is costly; the dosage regimen is onerous [13][14][15] ; and regular and sustained medical monitoring is necessary.…”

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Zidovudine Adherence in Persons with AIDS: The Relation of Patient Beliefs About Medication to Self-Termination of Therapy

et al. 1997

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OBJECTIVE: To examine the relation of patient beliefs about medication usage and adherence to zidovudine (ZDV) therapy in persons with AIDS. DESIGN: Face-to-face interviews were used to determine attitudes of persons with AIDS toward ZDV and other prescribed medications, history of ZDV usage, and sociodemographics. SETTING: A public hospital infectious disease clinic, an AIDS day care program, and an inpatient unit in a voluntary hospital where care was provided cooperatively by staff and an informal-care partner. PATIENTS/PARTICIPANTS: One hundred forty-one people with the acquired immunodeficiency syndrome agreed to be reinterviewed as part of a longitudinal, New York City-based study examining outcomes related to quality of life. Initial recruitment procedures were to approach all active AIDS patients at each of the three sites between January and July of 1992; reinterviews, which were conducted an average of 6 months later, occurred from mid-1992 through May of 1993. MEASUREMENTS AND MAIN RESULTS: The Zidovudine DrugAttitude Inventory was used to assess subjective feelings and attitudes concerning ZDV and prescribed medications in general. Respondents were grouped into five categories on the basis of their ZDV usage history: (1) "short-term" users (i.e., those who had been taking ZDV for 25 months or less); (2) "long-term" users (i.e., those who had been taking ZDV for more than 25 months); (3) self-terminated users; (4) doctorterminated users; and (5) never users. Long-term users were likely to view ZDV as an illness prophylactic. In contrast, self-terminated users and never users were most likely to believe that ZDV caused adverse side effects and that medicine need not be taken as prescribed.CONCLUSIONS: Patients' beliefs about ZDV were significantly associated with adherence-related behavior. In particular, those who had self-terminated ZDV treatment believed that taking the drug was harmful, were skeptical of its ability to prevent illness, and felt that physicians' directives about medication usage in general could be disregarded. These findings highlight the importance of educating patients about ZDV and of establishing regular patient-clinician exchanges concerning patients' experiences with and beliefs concerning ZDV. KEY WORDS: AIDS; adherence, zidovudine; patient beliefs. J GEN INTERN MED 1997;12:216-223.idovudine (ZDV) has been recognized as a leading antiretroviral therapy for the HIV since the release of clinical trials data in the late 1980s and early 1990s indicating that it delayed the development of symptomatic HIV infection and the onset of AIDS. 1,2 Current clinical guidelines specify ZDV for a broad spectrum of symptomatic and asymptomatic HIV-infected patients 3,4 ; it is estimated that over 600,000 persons in the United States alone are eligible for such treatment. 5 Demand for ZDV is likely to increase still further in light of new findings indicating that its effectiveness is enhanced when it is used in combination with other antiretroviral agents. 6 Despite the large and rapidly expa...

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Zidovudine Adherence in Persons with AIDS: The Relation of Patient Beliefs About Medication to Self-Termination of Therapy

et al. 1997

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“…We advise offering PCP prophylaxis in pregnancy at a similar CD4 level to nonpregnant individuals (200/mm 3 ) and discussing Zidovudine on a case by case basis. Many individuals, especially those with injection drug use as a background risk activity, have poor compliance with such therapy, but we have previously demonstrated that it is possible to treat drug users with Zidovudine (Cowan et al 1989). Treatment and prophylaxis during pregnancy have been excellently reviewed (Schoenbaum et al 1992).…”

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Johnstone¹,

Brettle

1993

BJOG

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of treatment and prophylaxis. Our cxperience of such therapy during pregnancy is very limited because most HIV infected pregnant patients have not been severely immunocompromised. However it seems reasonable to draw on information from other patient groups, as Dr Kell has done, demonstrating the benefit of PCP prophylaxis and antiretrovirals. Our own experience of death in acute PCP is that all patients dying during the first episode have neglected medical contact for the previous six months, even when they became unwell. Early recognition of medical condition is probably the most important factor in survival rather than risk activity, gender or pregnancy. In our series, the three women who developed PCP duringpregnancy were not taking prophylaxis (one disclosed her pregnancy only when she presented with PCP, one did not attend, and one was not known to be infected with HIV). We advise offering PCP prophylaxis in pregnancy at a similar CD4 level to nonpregnant individuals ( s200/mm3) and discussing Zidovudine on a case by case basis. Many individuals, especially those with injection drug use as a background risk activity, have poor compliance with such therapy, but we have previously demonstrated that it is possible to treat drug users with Zidovudine (Cowan et al. 1989). Treatment and prophylaxis during pregnancy have been excellently reviewed (Schoenbaum et al. 1992).We disagree slightly with some of Dr Kell's interpretations of the quoted papers:Kooninethl. (1989) did not describe deaths only in pregnant women but in women dying within a year of prcgnancy. Sperling et al. (1992) did not 'support the use of AZT' in pregnancy, but simply reported a retrospective review of 43 pregnancies where this drug was taken (12 in the first trimester) without serious immediate maternal or neonatal problems. The authors are careful to emphasise the limited number of cases, and also that early adverse outcomes of pregnancy, including teratogenic effects resulting in termination of pregnancy, could have been unintentionally under-reported. Although we agree with the overall framework of discussion suggested by Minkoff and Moreno (1990) we would advise caution in the literal acceptance of a CD4 count of 500/mm3 as an action line. This level is the upper limit of a band where an effect of ZDV prophylaxis has been demonstrated but it is not certain that individuals at the upper end of this band do in fact show long-term benefit. In addition, pregnancy results in a decrease in absolute CD4 count of about 100/mm3 in healthy, non-HIV infected women, and nearly 50% of a small group of such non-infected women had a CD4 count <500/mm3 at some time during pregnancy (unpublished work). There are also the confounding variables of smoking, cxcrcise, meals, timing of transport to the laboratory and. most importantly, diurnal variation which seem rarely mcntioned in advice about basing trealment on CD4 counts. Whcther anti-retroviral therapy may reduce vertical transmission rate is a key question but one which will not be answered for some...

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Differences in access to zidovudine (AZT) among symptomatic HIV-infected persons

et al. 1991

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Use of zidovudine for drug misusers infected with human immunodeficiency virus

Cited by 9 publications

References 5 publications

Zidovudine Adherence in Persons with AIDS: The Relation of Patient Beliefs About Medication to Self-Termination of Therapy

Zidovudine Adherence in Persons with AIDS: The Relation of Patient Beliefs About Medication to Self-Termination of Therapy

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Differences in access to zidovudine (AZT) among symptomatic HIV-infected persons

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