SURVIVAL OF PATIENTS RECEIVING ZIDOVUDINE BEFORE OR AFTER AIDS DIAGNOSIS - RESULTS OF A GERMAN MULTICENTER STUDY

While efficacy of zidovudine (ZDV) in the acquired immunodeficiency sy ndrome (AIDS) is well established, the issue of survival after early Z DV treatment is still controversial. To assess survival benefits of ZD V treatment prior to AIDS, as compared to treatment after the onset of AIDS, we used an observational analysis of infected individuals infec ted with human immunodeficiency virus treated with ZDV and/or prophyla xis against Pneumocystis carinii pneumonia prior to or after AIDS in c omparison to patients never treated with ZDV Nine German AIDS treatmen t centers entered case reports dating from January 1988 to January 199 2. A total of 1425 HIV-infected patients were included, mainly homo-/b isexuals: 1338 males and 87 females, with a mean age of 38.9 years. Of these, 262 had received ZDV prior to AIDS, 376 after AIDS, and 787 ha d never received ZDV. Survival from a first CD4 lymphocyte count below 0.200 x 10(9)/l (or below 0.500 x 10(9)/l) to death was assessed by m eans of Kaplan-Meier analysis. Survival did not differ significantly w hen the first CD4 count below 0.200 x 10(9)/l was taken as baseline. T he median survival of patients receiving ZDV prior to AIDS was 662 day s as compared to 572 days in patients treated after AIDS. Patients wit h earlier therapy showed longer survival in a subset of patients who w ere observed from their first CD4 count below 0.500 x 10(9)/l. Additio nal PcP prophylaxis significantly improved survival in all groups. We conclude that survival from the first CD4 count below 0.200 x 10(9)/l to death does not differ in patients receiving ZDV prior to or after A IDS. Additional PcP prophylaxis improves survival in ZDV-treated patie nts and patients without ZDV.