Document 0834
 DOCN  M95A0834
 TI    The value of the CD4+ count of 500 cells/microliters.
 DT    9510
 AU    Volberding P; AIDS Program, San Francisco General Hospital, California,
       USA.
 SO    Drugs. 1995;49 Suppl 1:4-8; discussion 38-40. Unique Identifier :
       AIDSLINE MED/95339782
 AB    The CD4+ cell count is a surrogate marker used for evaluating the
       efficacy of therapies for HIV infection and for estimating the prognosis
       of patients with HIV infection. However, there is no single CD4+ count
       that can be used to indicate likely clinical outcome or the optimal time
       of treatment initiation. Protocol 019 of the AIDS Clinical Trials Group
       (ACTG) investigated the efficacy of zidovudine monotherapy in
       asymptomatic patients with HIV infection. Following results showing
       zidovudine to be significantly more effective than placebo in delaying
       the progression to AIDS in HIV-infected patients with CD4+ counts < 500
       cells/microliters, further analysis of data from this trial showed that
       immediate zidovudine significantly delayed the time to reach a CD4+
       count of 500 cells/microliters in patients with > 500 cells/microliters
       compared with deferred therapy. However, there was no additional
       advantage in terms of delayed onset of AIDS or death compared with
       deferred treatment. Based on the available evidence, our group believes
       that the threshold for initiating zidovudine monotherapy should be a
       CD4+ count of 500 cells/microliters. However, we also strongly advocate
       additional research to confirm the value of early treatment with
       zidovudine in asymptomatic patients. Continuing educational and
       collaborative research efforts will further clarify optimal therapeutic
       strategies in asymptomatic patients with HIV infection.
 DE    Acquired Immunodeficiency Syndrome/IMMUNOLOGY/PREVENTION &  CONTROL
       *CD4 Lymphocyte Count  Dose-Response Relationship, Drug  Human  HIV
       Infections/*DRUG THERAPY/IMMUNOLOGY  Prognosis  Randomized Controlled
       Trials  Zidovudine/*THERAPEUTIC USE  JOURNAL ARTICLE  REVIEW  REVIEW,
       TUTORIAL

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