REPORT ON A 3-YEAR FOLLOW-UP ZIDOVUDINE (AZT) TREATMENT IN A GROUP OFHIV-POSITIVE PATIENTS WITH CONGENITAL CLOTTING DISORDERS

Eleven (50%) of 22 HIV-seropositive patients suffering from congenital coagulation defects and followed at the Hemophilia Center of Padua me t the eligibility criteria for zidovudine (AZT) therapy. A 3-year clin ical and laboratory follow up is described. Mean length of AZT treatme nt was 14.3 +/- 11 months. Three patients were enrolled at the latest stages (CDC stage IV) of HIV disease. They showed no clinical improvem ent after AZT administration and died with AIDS. One CDC stage III pat ient died from a high-grade non-Hodgkin's lymphoma (NHL) which suddenl y developed 3 months after stalling AZT. Seven patients began antiretr oviral treatment when they were mild or asymptomatic for HIV infection (CDC stage II and III). None developed any sip of HIV disease progres sion on the basis of CDC criteria. Moreover, AZT administration induce d an improvement of the humoral markers related to HIV disease, as CD4 T-lymphocyte count, serum beta2-microglobulin (B2M) and, although onl y for few months, neopterin (Np) levels. A mild thrombocytopenia due t o HIV infection was detected in 5 patients. In all cases AZT treatment was effective in increasing and/or normalizing the platelet count. Re duced daily dose AZT (600-500 mg/day) appeared to be well tolerated an d of minimal toxicity as compared to the higher dose (1200 mg/day). In our study, the zidovudine-induced bone marrow suppression, namely sev ere anemia or pancytopenia, was the major side-effect limiting toleran ce of the higher dose AZT.