Colson E R, Horwitz R I, Bia F J, Viscoli C M
Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn. 06510.
Arch Intern Med. 1991 Apr;151(4):709-13.
To learn about the patterns of use and the effectiveness of zidovudine therapy in clinical practice, we conducted an observational cohort study of 86 patients with human immunodeficiency virus type 1 infection. All patients were followed up for at least 6 months after starting zidovudine (AZT) therapy. Of the 86 patients, 78 (91%) initially received full-dosage zidovudine (1200 mg/d), and eight received a reduced dosage (600 mg/d). During follow-up, the number able to maintain full-dosage zidovudine therapy decreased to 54 (63%) at 3 months and 40 (47%) at 6 months. Thirty-five patients required dosage reductions that lasted at least 7 days and were not preceded by an adverse outcome (death or opportunistic infection). Overall, adverse outcomes occurred for nine (26%) of those with dosage reductions compared with 22 (43%) of 51 patients with no previous dosage change. Even after adjusting for baseline cytopenias and the time of the dosage reductions, adverse outcomes did not occur significantly more often in patients who received reductions in their zidovudine dosage. Our results indicate that full-dosage zidovudine therapy cannot be maintained for most patients infected with human immunodeficiency virus, but that clinicians need not be pessimistic about treatment outcomes when dosage reductions are needed.
为了解齐多夫定疗法在临床实践中的使用模式及疗效，我们对86例1型人类免疫缺陷病毒感染患者进行了一项观察性队列研究。所有患者在开始齐多夫定（AZT）治疗后至少随访6个月。86例患者中，78例（91%）最初接受全剂量齐多夫定（1200毫克/天）治疗，8例接受减量治疗（600毫克/天）。在随访期间，能够维持全剂量齐多夫定治疗的患者人数在3个月时降至54例（63%），6个月时降至40例（47%）。35例患者需要减量治疗，且减量持续至少7天，减量前无不良结局（死亡或机会性感染）。总体而言，减量治疗的患者中有9例（26%）出现不良结局，而51例之前未改变剂量的患者中有22例（43%）出现不良结局。即使在对基线血细胞减少症和减量时间进行校正后，接受齐多夫定剂量减少的患者出现不良结局的频率也没有显著增加。我们的结果表明，大多数感染人类免疫缺陷病毒的患者无法维持全剂量齐多夫定治疗，但当需要减量时，临床医生不必对治疗结果感到悲观。
