Early therapeutic intervention in HIV infection--stepping stones to success

The improvement in survival observed in symptomatic HIV disease in the last three years may be accounted for by factors over and above the introduction of zidovudine therapy. Such factors include earlier diagnosis and advances in the treatment and prophylaxis of life threatening opportunistic infections. These advances in the management of symptomatic HIV disease considerably influenced the move towards early intervention in asymptomatic infected individuals. Currently two developments are changing clinical practice, namely the primary prophylaxis of pneumocystis carinii pneumonia and antiretroviral treatment with zidovudine. This review concerns itself with the scientific data supporting such changes in practice and the uncertainties and unanswered questions that remain, particularly with respect to the timing of intervention with and appropriate dose of zidovudine.