Stambuk D, Youle M, Hawkins D, Farthing C, Shanson D, Farmer R, Lawrence A, Gazzard B
St Stephens Hospital, London.
Q J Med. 1989 Feb;70(262):161-74.
The efficacy and toxicity of oral azidothymidine has been studied in 145 patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC). The median survival time of AIDS patients on azidothymidine was 4.5 times higher when compared to a historical AIDS group who had not received the drug. This result must be interpreted with caution because of changes in treatment of HIV infection and growing awareness of AIDS which may have led to earlier diagnosis in the group treated with azidothymidine. The mortality was significantly higher in those patients who received transfusions and was particularly high in those who were transfused before azidothymidine. There was a significant difference in the occurrence of opportunistic infections in the patients who received transfusions compared with those who did not. AIDS patients treated immediately after an episode of Pneumocystis carinii pneumonia survived significantly longer than those in whom treatment was delayed for three months or more, and longer than those who were treated with azidothymidine because of another opportunistic infection or Kaposi's sarcoma. The T4 cell median counts increased in patients treated with azidothymidine reaching a peak at the end of the fourth month of treatment in the ARC group and at the end of the first month in the AIDS group with a subsequent fall in both groups. Sixty per cent of patients were p24 viral antigen positive at the start of treatment and 19 per cent of these patients had a fall of more than 50 per cent in antigen level while 32 per cent became antigen negative following treatment with azidothymidine. The mortality in the patients where the antigen disappeared or in whom there was a major fall of more than 50 per cent in antigen level was significantly less than in those where there was no change in antigen level. Twenty-nine patients were treated with azidothymidine because of skin Kaposi's sarcoma and in 17 tumour regressed or was stable. Thirty-two per cent of patients treated with azidothymidine became anaemic. Neutropenia occurred in 3 per cent of patients. Platelets increased initially after treatment but subsequently fell to thrombocytopenic levels in eight patients. Nine of 12 patients with thrombocytopenia before azidothymidine was commenced responded with an increased platelet count.
对145例获得性免疫缺陷综合征（AIDS）或AIDS相关综合征（ARC）患者研究了口服叠氮胸苷的疗效和毒性。与未接受该药物治疗的历史AIDS组相比，接受叠氮胸苷治疗的AIDS患者的中位生存时间高出4.5倍。由于HIV感染治疗的变化以及对AIDS认识的不断提高，可能导致接受叠氮胸苷治疗组的诊断更早，因此对这一结果的解释必须谨慎。接受输血的患者死亡率显著更高，在接受叠氮胸苷治疗前输血的患者中死亡率尤其高。接受输血的患者与未接受输血的患者相比，机会性感染的发生率存在显著差异。卡氏肺孢子虫肺炎发作后立即接受治疗的AIDS患者存活时间明显长于治疗延迟三个月或更长时间的患者，也长于因另一种机会性感染或卡波西肉瘤而接受叠氮胸苷治疗的患者。接受叠氮胸苷治疗的患者T4细胞中位计数增加，在ARC组治疗第四个月末达到峰值，在AIDS组第一个月末达到峰值，随后两组均下降。60%的患者在治疗开始时p24病毒抗原呈阳性，其中19%的患者抗原水平下降超过50%，32%的患者在接受叠氮胸苷治疗后抗原转阴。抗原消失或抗原水平下降超过50%的患者死亡率显著低于抗原水平无变化的患者。29例因皮肤卡波西肉瘤接受叠氮胸苷治疗的患者中，17例肿瘤消退或稳定。接受叠氮胸苷治疗的患者中有32%出现贫血。3%的患者出现中性粒细胞减少。治疗后血小板最初增加，但随后8例患者降至血小板减少水平。在开始使用叠氮胸苷前有血小板减少的12例患者中，9例患者血小板计数增加。
