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Early or Deferred Zidovudine Therapy in HIV-Infected Patients without an AIDS-Defining Illness: A Meta-Analysis

John P. A. Ioannidis, MD; Joseph C. Cappelleri, PhD, MPH; Joseph Lau, MD; Paul R. Skolnik, MD; Barbara Melville, BA; Thomas C. Chalmers, MD; and Henry S. Sacks, PhD, MD
[+] Article and Author Information

From Tufts University School of Medicine and New England Medical Center Hospitals, Boston, Massachusetts; and Mount Sinai School of Medicine, New York, New York. Requests for Reprints: Joseph Lau, MD, Division of Clinical Care Research, New England Medical Center, Box 63, 750 Washington Street, Boston, MA 02111.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1995;122(11):856-866. doi:10.7326/0003-4819-122-11-199506010-00009
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Purpose: To do a meta-analysis on the efficacy of early or deferred zidovudine monotherapy in patients with human immunodeficiency virus (HIV) infection but not the acquired immunodeficiency syndrome (AIDS).

Data Sources: Articles on zidovudine monotherapy published through May 1994.

Study Selection: Double-blind, randomized, placebo-controlled trials addressing the efficacy of zidovudine monotherapy in HIV-infected persons without an AIDS-defining illness.

Data Extraction: Progression to any primary trial end point; any clinical end point; and AIDS or death. Data were stratified according to disease stage at study entry and duration of follow-up (short-term, <14 months; long-term, >21 months).

Data Synthesis: Early initiation of zidovudine therapy was of short-term benefit for all the end points evaluated (for example, the risk ratio for progression to any primary end point was 0.51; 95% CI, 0.41 to 0.64). Long-term trials showed a marginally significant trend of decreased progression to any primary end point (risk ratio, 0.73; CI, 0.52 to 1.03). The trend was not significant for other end points. With further stratification according to disease stage, progression to AIDS or death in the short term was significantly decreased for both symptomatic and asymptomatic patients with CD4 cell counts of less than 500 × 106/L (risk ratios, 0.26 [CI, 0.13 to 0.56] and 0.43 [CI, 0.30 to 0.64], respectively). A regression analysis indicated a larger relative benefit in short-term trials and symptomatic patients than in long-term trials and asymptomatic patients.

Conclusions: Early initiation of zidovudine therapy offers a benefit that decreases over time. Symptomatic patients experience a larger benefit than asymptomatic patients. The implications beyond 3 years of follow-up remain unknown.

Figures

Grahic Jump Location
Figure 1.
Incidence rate ratios for progression to any primary end point.

Calculations are based on events per patient-years. ACTG = AIDS Clinical Trials Group; AZTCG = Azidothymidine Collaborative Working Group; EACG = European-Australian Collaborative Group; VA = Veterans Administration; ZDV = zidovudine.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Risk ratios for progression to the acquired immunodeficiency syndrome or death.

Calculations are based on events per number of patients. ACTG = AIDS Clinical Trials Group; AZTCG = Azidothymidine Collaborative Working Group; EACG = European-Australian Collaborative Group; VA = Veterans Administration; ZDV = zidovudine.

Grahic Jump Location

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