COMPARISON OF HYDROXYCHLOROQUINE WITH ZIDOVUDINE IN ASYMPTOMATIC PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1

Hydroxychloroquine (HCQ), an antimalarial agent used to treat patients with autoimmune diseases, has been shown to suppress human immunodefi ciency virus type 1 (HIV-1) replication in T cells and monocytes in vi tro by inhibiting posttranscriptional modification of the virus. An in itial randomized, placebo-controlled clinical trial conducted in 38 as ymptomatic HIV-l-infected patients who had CD4+ counts between 200 and 500 cells/mm(3) demonstrated that the amount of recoverable virus dec lined significantly in the HCQ group compared with the placebo group o ver the 8-week study period. These preliminary observations were expan ded into a second 16-week clinical trial comparing the efficacy of HCQ with that of zidovudine (ZDV) in 72 asymptomatic HIV-l-infected patie nts with CD4+ counts between 200 and 500 cells/mm3 Patients were rando mly assigned to receive either HCQ 800 mg/d (n = 35) or ZDV 500 mg/d ( n = 37) for 16 weeks. No adverse reactions to the study medications we re observed in either the HCQ or ZDV group. Patients in both groups ha d reduced levels of recoverable HIV-1 RNA in the plasma, reduced level s of cultured virus, and reduced levels of serum p24 antigen after the 16-week study period. However, no difference was noted in absolute CD 4+ counts between the two groups. Interleukin-6 and serum immunoglobul in G levels were significantly reduced in the HCQ group but not in the ZDV group. These findings support the results of the previous clinica l trial. Thus HCQ may be potentially useful in the treatment of patien ts with HIV-1 infection.