Subject: AIDS Experts Ease Stance Supporting Early AZT Treatment, Make It Optional 
Date: Published: 6/28/93 (65 lines)
Source: Wall Street Journal. Copyright Dow Jones & Co. Inc.

    Technology:
    AIDS Experts Ease Stance Supporting
    Early AZT Treatment, Make It Optional
    ----
    By Marilyn Chase
    Staff Reporter of The Wall Street Journal

    A panel of AIDS experts backed away from the U. S. stand
 supporting early AZT treatment for HIV infection, leaving the matter
 as a judgment call between doctor and patient.
    Debate was ignited this spring after an Anglo-French research
 team published a report, known as the Concorde study, showing that
 early AZT treatment doesn't prolong survival of people with HIV
 infection who start taking the drug before they develop AIDS.  
    The National Institutes of Health previously recommended that
 patients with HIV infection take the Wellcome PLC drug as soon as
 their immune systems decline to a point where disease-fighting white
 blood cells known as CD4 cells fall to 500, or roughly half the
 normal level.  After three days of public hearing and private
 deliberation, the panel convened by the NIH backed away from that
 position.
    The panel's recommendation is likely to cool the enthusiasm of
 physicians prescribing AZT for infected people who don't yet have
 AIDS.  Hence, the panel decision may cool AZT sales in Wellcome's
 large U. S. market.  An estimated one million Americans are infected
 with HIV.  
    The U. S. standard of practice "is now tempered to say early
 treatment with AZT becomes part of the decision process between
 doctor and patient," said Anthony S. Fauci, director of the National
 Institute of Allergy and Infectious Diseases, in an interview.  Some
 U. S. data contradicts Concorde, suggesting early treatment may
 benefit some patients, he said.  "But the option of not treating
 early HIV infection is a viable option," he added.
    Left unchanged is the consensus that patients who have developed
 AIDS symptoms "should start {antiviral} therapy," Dr. Fauci said.  He
 said AZT remains "the first line of defense" among several
 antivirals.
    For people who cannot tolerate AZT's side effects, like anemia,
 and for people whose illness worsens despite AZT treatment, the
 panel recommended switching to another antiviral drug, Bristol-Myers
 Squibb Co. 's DDI.  
    Depending on a patient's symptoms and immune status, the panel
 offered a wide menu of recommendations and options -- including the
 Roche Holding Ltd.  drug DDC, and various drug combinations designed
 to evade both debilitating side effects and drug-resistant viruses.
 The panel's formal recommendations will be published this summer,
 Dr. Fauci said.
    Dr. Fauci said all people with HIV should seek a doctor's care
 and be medically monitored as soon as they are discovered to carry
 the virus.  Good care and a healthy lifestyle can improve quality and
 length of life.
    "Don't confuse the concept of early intervention" with AZT alone,
 he said.  "Early intervention can mean seeing your physician, getting
 good general medical care.  We don't want people thinking:  `Early
 intervention doesn't matter, and who the hell cares if you're HIV
 positive?'"

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