Stein DS, Graham NM, Park LP, Hoover DR, Phair JP, Detels R, Ho M, Saah AJ; International Conference on AIDS.

Int Conf AIDS. 1994 Aug 7-12; 10: 22 (abstract no. 060B).

Johns Hopkins University, Baltimore, MD 21205.

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.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Acyclovir
• CD4 Lymphocyte Count
• Cohort Studies
• Disease Progression
• HIV Infections
• HIV Seropositivity
• Humans
• Longitudinal Studies
• Male
• Multicenter Study
• Proportional Hazards Models
• Prospective Studies
• Survival
• Survival Analysis
• Zidovudine
• mortality

Other ID:

• 94369764

UI: 102208590

From Meeting Abstracts