The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

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, Author, and Disclosure 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
Text Size: A A A

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.


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




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.