A nationwide team of scientists has found that people who take the anti-AIDS drug, AZT, early in their infection not only delay symptoms but also live longer than those who wait until they are diagnosed with full-blown AIDS.
"AZT is absolutely not a cure, but it delays AIDS and even delays death," said Dr. Neil Graham, an epidemiologist with the Johns Hopkins School of Hygiene and Public Health. The study involved 2,568 homosexual or bisexual men from Baltimore, Washington, Chicago, Pittsburgh and Los Angeles.
While confirming the beliefs of many physicians, the study appears to draw different conclusions than did a recent study by Veterans Administration doctors. That study, involving a smaller number of patients, found that men taking the drug early did indeed forestall the onset of disease but died faster once they were diagnosed with acquired immune deficiency syndrome.
The drug was approved by the Food and Drug Administration in March 1987 after studies showed that it slowed the destruction of the immune system in patients diagnosed with AIDS. Three years later, the government expanded the drug's labeling to include people who were infected with the AIDS virus but had not yet developed symptoms of the full-blown disease.
The FDA action was based on data suggesting that the drug could help people in the early stages of infection by staving off the first symptoms of AIDS. But the question remained: Do patients live longer in the long run?
The latest study, reported in today's New England Journal of Medicine, followed gay or bisexual men who tested positive for the AIDS virus or became positive during the course of the study -- but who had yet to develop AIDS when they enrolled.
"People made their own decision whether to take the drug or not," Dr. Graham said. "We had no input into that." But scientists monitored the men every six months -- comparing, among other things, death rates among men who took AZT at different stages of their infection.
After six months of follow-up, there were 57 percent fewer deaths among the men who received early AZT treatment -- and 46 percent fewer deaths at 12 months, 41 percent fewer at 18 months and 33 percent fewer at 24 months.
Men who also took other drugs to prevent a deadly respiratory infection called pneumocystis pneumonia delayed their death a little longer.
Nothing erases the reality that the disease kills practically everyone -- if not everyone -- it strikes.
Before the advent of AZT, patients lived an average of 13 months after their initial diagnosis with AIDS. Early treatment with AZT may add "a year or two" to the average patient's life, Dr. Graham estimated, although he added that many must discontinue the drug because of side effects.
Physicians have gone beyond treatment with AZT alone -- experimenting, in many cases, with the combinations of that drug and newer anti-viral medications such as DDI. While conflicting studies leave the benefits of AZT somewhat clouded, Dr. Scott Zeger said future studies may be concerned more with the benefits of combination therapies.
"We're moving on in the treatment world," said Dr. Zeger, a professor of biostatistics at Hopkins. "The number of people using AZT alone as time goes by may decrease."
And Dr. Graham noted that the most important issue may be the failure of many patients to gain access to any drugs at all until they are close to death. Last year, a Hopkins study found that half of all AIDS patients in Baltimore didn't even get AZT because they were poor or simply disconnected from the health care system.
"The bottom line is these drugs work and do give extra survival benefit," Dr. Graham said. "The tragedy is, the American health care system is in such disarray. The people who need drugs just can't get them. That's what worries me about this whole process."