AIDS in Arkansas. Zidovudine: an overview and rationale for use

AZT is now the standard of care for all persons with AIDS, ARC or T4 helper cell levels less than 200/mm3. Some authorities are cautiously recommending it with full informed consent for patients who have fewer than 400 mm3 T4 cells or who have sustained a rapid fall in helper cells coupled with new symptoms. The optimum dosage remains to be determined. Although the package insert recommends 200mg p.o. q. 4 hours, b.i.d. and Q6 hour dosage regimes have been reported as being as effective with less toxicity. Folate and B12 levels should be measured and replaced when appropriate to avoid undue hematologic toxicity and therapy should be interrupted for hemoglobin less than 7.5 or neutropenia consisting of fewer than 750 leukocytes/cc. For progressive, less severe marrow toxicity the dose may be decreased to avoid a prolonged nadir. A CBC should be obtained every two weeks for at least the first eight weeks and monthly thereafter if counts are stable. Other toxicities to be monitored include elevated transaminases and co-administration with medications that affect hepatic glucuronidation such as probenecid, NSAID's and acetaminophen. In the eight years since this epidemic appeared on the medical horizon much has been learned about the disease and its treatment. More and more physicians are willing and eager to assume primary care responsibilities for their patients with AIDS and it is hoped AZT and other effective therapies will assist them in this process.