Document 2811
 DOCN  M94A2811
 TI    Acyclovir/zidovudine combination therapy and AIDS survival. Multicenter
       AIDS Cohort Study.
 DT    9412
 AU    Stein DS; Graham NM; Park LP; Hoover DR; Phair JP; Detels R; Ho M; Saah
       AJ; Johns Hopkins University, Baltimore, MD 21205.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(1):22 (abstract no. 060B). Unique
       Identifier : AIDSLINE ICA10/94369764
 AB    OBJECTIVE: To examine the effect of acyclovir use on disease progression
       and survival in zidovudine treated HIV + individuals. METHODS:
       Prospective cohort study of gay and bisexual men seen semiannually.
       Intent to treat Cox models were fit to determine the relationship
       between use of acyclovir (modelled as a time dependent covariate) and
       disease progression controlling for baseline (hemoglobin, platelets) and
       time dependent (CD4 count, HIV symptoms, PCP prophylaxis, herpes
       episodes, and other antiretroviral therapy) prognostic variables.
       AIDS-free and survival times were calculated from the first use of
       zidovudine (n = 786). Acyclovir use was defined as acyclovir-any (n =
       488; acyclovir use for herpes or HIV) or acyclovir-HIV, (n = 242; HIV
       indication only: postulated to have higher dose, less intermittent use).
       RESULTS: Acyclovir was not associated with effects on progression to
       AIDS or CMV. Acyclovir-any was associated with a 26% decrease in risk of
       death (RH = 0.74, P = 0.07) and acyclovir-HIV was associated with a 36%
       decrease in risk of death (RH = 0.64, P = 0.01). Greater constancy, but
       not dose of acyclovir use was related to better survival. Acyclovir-any
       and acyclovir-HIV were significantly associated with a 44% decreased
       probability of death if used post-AIDS (P = 0.007 and P = 0.005
       respectively), but not pre-AIDS. Landmark analysis, using multivariate
       Cox models, gave estimated median survival times of 1018, 745 and 544
       days for men with CD4 count < 50 or AIDS comparing those who started
       acyclovir at or prior, either never or after, and never, respectively
       after the landmark point. CONCLUSIONS: Consistent use of acyclovir in a
       dose sufficient to suppress herpetic recurrences (600-800 mg/d) may have
       a significant impact on prolonging survival.
 DE    Acquired Immunodeficiency Syndrome/*DRUG THERAPY/MORTALITY
       Acyclovir/*ADMINISTRATION & DOSAGE  Cohort Studies  Drug Therapy,
       Combination  Herpesviridae Infections/PREVENTION & CONTROL  Human  HIV
       Seropositivity/*DRUG THERAPY  Leukocyte Count  Male  Multivariate
       Analysis  Prospective Studies  Survival Analysis  T4 Lymphocytes
       Zidovudine/*ADMINISTRATION & DOSAGE  MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).