Subject: Study Discloses Limits of AZT In Fighting HIV 
Date: Published: 2/13/92 (63 lines)
Source: Wall Street Journal. Copyright Dow Jones & Co. Inc.

    Technology & Medicine:
    Study Discloses
    Limits of AZT
    In Fighting HIV
    ----
    By Marilyn Chase
    Staff Reporter of The Wall Street Journal

    Early treatment with the drug AZT can slow an erosion of
 the immune system and delay the onset of AIDS, but it doesn't
 prolong the lifespan of people infected with human
 immunodeficiency virus, HIV, researchers said.
    The finding in a four-year study of 338 people with HIV
 underscores the limited benefits of the drug, manufactured by
 Wellcome PLC, and increases the urgency to develop
 alternative treatments for the epidemic.
    In the study, researchers assigned half the patients to
 receive AZT and the rest to wait until a drop in their levels
 of immune sentry cells, known as CD4 cells, to less than 200
 per cubic millimeter.
    People in the early treatment group experienced a slower
 plunge in their immune cells and a delayed appearance of AIDS
 symptoms.  But in the end, their survival rates weren't
 improved, according to the report's author, Duke University
 researcher John D. Hamilton and his colleagues in the
 Department of Veteran's Affairs hospital system.  Their
 report, in this week's New England Journal of Medicine, also
 said the early treatment group experienced more nausea and
 other side effects.
    The question remains, how can a drug that bolsters the
 immune system and delays the onset of the disease, fail to
 extend life for these patients?  Most researchers believe it
 is because AZT's benefits only last a year or two, and
 growing viral resistance to the drug permits the ultimate
 collapse of the immune system.
    Other researchers said the articles highlight the need to
 hasten the development of alternate treatments, and
 combination therapy.
    "AZT, while a useful drug, leaves lots of room for
 improvement.  We need to be moving along to other approaches,"
 said Daniel Hoth of the Division of AIDS at the National
 Institute of Allergy and Infectious Diseases.
    The report also re-ignites the debate over when doctors
 should treat people infected with the AIDS virus.  Current
 recommendations are that treatment with AZT should begin as
 soon as the immune cell levels fall below 500 -- or roughly
 half the normal level of 1000 or more.
    The report's authors urged doctors to consider backing
 away from early treatment, and delaying AZT until such immune
 cells fall below 200.  In an interview, Dr. Hoth disagreed,
 suggesting the drug may be improving the quality of life by
 postponing AIDS symptoms.
    "We see nothing to suggest a change in the current
 recommendations, which are to use AZT in patients with fewer
 than 500 CD4 cells," Dr. Hoth said.

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