Clinical aspects of human immunodeficiency virus disease: clinical rationale for treatment

Guidelines regarding the use of antiretroviral therapy in adult patients infected with human immunodeficiency virus have been based primarily on the results of 15 major clinical trials in which patients have been categorized according to CD4 cell counts, symptoms, prior therapy, and conditions. In patients with limited treatment experience and advanced disease, zidovudine monotherapy is associated with improved survival, whereas only a transient delay in progression of disease is observed in patients with>200 CD4 cells/mm³ Adding zalcitabine to the treatment regimen of zidovudine-experienced patients with advanced disease has not been demonstrated to be of clinical benefit, whereas switching these patients to didanosine may delay disease progression. The effect of any antiretroviral therapy in zidovudine-experienced patients with <50 CD4 cells/mm’ remains indeterminate. The perinatal transmission rate can be reduced by as much as two-thirds when zidovudine is administered to women after the first trimester.