Tozzi V, Narciso P, Galgani S, Sette P, Balestra P, Gerace C, Pau F M, Pigorini F, Volpini V, Camporiondo M P
Ospedale L. Spallanzani for Infectious Diseases, Rome, Italy.
AIDS. 1993 May;7(5):683-92. doi: 10.1097/00002030-199305000-00012.
Zidovudine (ZDV) is an inhibitor of HIV replication that may have a beneficial effect on patients with AIDS dementia complex (ADC). However, little is known about the association between long-term ZDV treatment and severity of ADC, ZDV dose or clinical and laboratory response to therapy.
An open study on ZDV administration in 30 consecutive patients with ADC.
An infectious diseases hospital.
Thirty consecutive patients followed-up for 12 months.
Three oral ZDV doses were used: 1000 mg (nine patients), 750 mg (eight patients) and 500 mg (13 patients) per day, depending on haematological status.
Clinical and neurological examinations, neuropsychological evaluations, high-field brain magnetic resonance imaging (MRI) and 99mTc-HM-PAO single photon emission computerized tomography (SPECT).
A favourable clinical response, defined as reversal to a less severe ADC stage (Price and Brew's criteria), was observed after 1, 3, 6, 9 and 12 months in 15, 22, 25, 19 and 14 patients, respectively. Neither severity of ADC at entry nor ZDV dose correlated with response to treatment. Seven patients died during the 12-month follow-up. The only factor associated with longer survival was ADC severity at entry (12-month survival, 0.94 and 0.53, in patients in stages 1 or 2 and in stages 3 or 4, respectively; P < 0.01). After 6-12 months of ZDV treatment six patients who initially responded to therapy showed a relapse in initial ADC stage, and two patients a less severe neurological deterioration. Neuropsychological evaluations showed significant improvement in the Wisconsin Card-Sorting test (P = 0.006 for categories, P = 0.029 for perseverative errors), which is particularly sensitive to cognitive and frontal-lobe type functions. Brain MRI revealed a reduction of the extent of white matter lesions in six out of 13 patients, who also showed clinical improvement. SPECT scanning revealed a reduction in the extent of uptake defects concomitant with clinical response in nine out of 14 patients.
ZDV is effective in most patients with mild to end-stage ADC, although the benefit is sometimes only transient; several relapses and deaths occurred after the sixth month of treatment.
齐多夫定（ZDV）是一种HIV复制抑制剂，可能对艾滋病痴呆综合征（ADC）患者有益。然而，关于长期ZDV治疗与ADC严重程度、ZDV剂量或治疗的临床及实验室反应之间的关联，人们知之甚少。
对30例连续的ADC患者进行ZDV给药的开放性研究。
一家传染病医院。
30例连续患者，随访12个月。
根据血液学状况，使用三种口服ZDV剂量：每天1000毫克（9例患者）、750毫克（8例患者）和500毫克（13例患者）。
临床和神经学检查、神经心理学评估、高场脑磁共振成像（MRI）和99mTc-HM-PAO单光子发射计算机断层扫描（SPECT）。
分别在1、3、6、9和12个月时，观察到15、22、25、19和14例患者出现了良好的临床反应，定义为病情逆转至较不严重的ADC阶段（普赖斯和布鲁标准）。入组时的ADC严重程度和ZDV剂量均与治疗反应无关。在12个月的随访期间，7例患者死亡。与较长生存期相关的唯一因素是入组时的ADC严重程度（1或2期患者12个月生存率为0.94，3或4期患者为0.53；P<0.01）。在ZDV治疗6 - 12个月后，6例最初对治疗有反应的患者在初始ADC阶段出现复发，2例患者出现较轻的神经功能恶化。神经心理学评估显示威斯康星卡片分类测试有显著改善（类别方面P = 0.006，持续性错误方面P = 0.029），该测试对认知和额叶类型功能特别敏感。脑部MRI显示13例患者中有6例白质病变范围缩小，这些患者同时也有临床改善。SPECT扫描显示14例患者中有9例摄取缺陷范围缩小，同时伴有临床反应。
ZDV对大多数轻度至晚期ADC患者有效，尽管益处有时只是短暂的；治疗6个月后出现了几次复发和死亡。
