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Comparison of Long-term Prognosis of Patients With AIDS Treated and Not Treated With Zidovudine
Jens D. Lundgren, MD, DSc;
Andrew N. Phillips, PhD;
Court Pedersen, MD, DSc;
Nathan Clumeck, MD;
Jose M. Gatell, MD, PhD;
Anne M. Johnson, PhD;
Bruno Ledergerber, PhD;
Stefano Vella, MD;
Jens O. Nielsen, MD, MSc;
N. Clumeck;
S. DeWit;
B. Sommereijns;
J. O. Nielsen;
J. Lundgren;
T. Nielsen;
C. Pedersen;
G. Jensen;
P. Skinhøj;
K. Bentsen;
J. Gerstoft;
M. Melbye;
A. Ranki;
S.-L. Valle;
C. Katlama;
P. Berlureau;
M. Dietrich;
S. Schwander;
F.-D. Goebel;
J. Kosmidis;
G. Stergiou;
T. Gouzia;
A. Papadopoulos;
D. Banhegyi;
F. Mulcahy;
I. Yust;
Z. Ben-Ishai;
Z. Bentwich;
T. Sacks;
S. Maayan;
S. Vella;
A. Chiesi;
F. Ancarani;
G. Scalise;
A. Bertaggia;
E. Francavilla;
G. Calonghi;
Arcispedale S. Maria Nuova;
Reggio Emilia;
A. Cargnel;
M. Arlotti;
R. Ciammarughi;
A. Colomba;
F. DeLalla;
P. Fassio;
A. Ferlini;
F. Fiaccadori;
G. Pasetti;
F. Giannelli;
W. Grillone;
A Lazzarin;
A. D'Arminio Monforte;
E. Mignani;
A. Nunnari;
L. Ortona;
G. Panichi;
S. Pauluzzi;
N. Piersantelli;
S. Ranieri;
P. Ricciardiello;
B. Roscioli;
M. Soranzo;
R. Hemmer;
S. Danner;
D. Bloemkolk;
F. Antunes;
R. Proenca;
J. González-Lahoz;
L. Martinez-Blanco;
B. Clotet;
J. Gatell;
E. Buira;
J. Miró;
P. Pehrson;
R. Lüthy;
B. Ledergerber;
K. Olsson;
M. Glauser;
B. Hirschel;
A. Johnson;
S. Hawkes;
A. Phillips;
S. Barton;
J. Morcinek;
A. Pinching;
D. Coleman;
I. Gjprup;
J. Lundgren;
J. Nielsen;
C. Nieport;
C. Pedersen;
L. Teglbjaerg;
A. Thornval
JAMA. 1994;271(14):1088-1092.
Abstract
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Objective.
—To determine the association between elapsed time since starting zidovudine and survival in patients with acquired immunodeficiency syndrome (AIDS).
Design.
—Inception cohort and observational study of patients treated and not treated with zidovudine.
Setting.
—Fifty-one centers in 17 European countries.
Patients.
—A total of 4484 patients diagnosed as having AIDS from 1979 to 1989 who survived their initial AIDS-defining event and who had not started zidovudine before AIDS diagnosis.
Main Outcome Measures.
—Use of zidovudine and mortality.
Results.
—Among patients who did not receive zidovudine, the death rate was approximately constant for the first 5 years after AIDS diagnosis. For patients treated with zidovudine, the death rate within the first year since starting zidovudine was markedly lower than for untreated patients who had developed AIDS at the same time (relative rate, 0.47; 95% confidence interval [CI] 0.42 to 0.51). For longer times since starting zidovudine, the association with reduced mortality rate was diminished, and for patients surviving more than 2 years since starting zidovudine, the death rate was greater than for untreated patients who had developed AIDS at the same time (relative rate, 1.35; 95% CI, 1.15 to 1.58). Adjustment for other prognostic factors failed to substantially affect this observation.
Conclusions.
—When initiated after the time of AIDS diagnosis, zidovudine was associated with improved prognosis but for no more than 2 years after starting therapy.
(JAMA. 1994;271:1088-1092)
Author Affiliations
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AIDS in Europe Study Group; Belgium; Saint-Pierre Hospital, Brussels; Denmark; Hvidovre Hospital; Frederiksberg Hospital; Rigshospitalet, Copenhagen; Finland; University Central Hospital, Helsinki; France; Hospital de la PitiéSalpétrière, Paris; Germany; Bernhard-Nocht-Institut, Hamburg; Medizinische Poliklinik, Munich; Greece; Athens General Hospital; 1st IKA Hospital, Athens; Hungary; Postgraduate Medical School, Budapest; Ireland; St James's Hospital, Dublin; Israel; Ichilov Hospital, Tel Aviv; Rambam Medical Center; Haifa; Kaplan Hospital, Rehovot; Ha-; dassah University Hospital, Jerusalem; Italy; Istituto Superiore di Sanità, Rome; Universitá di Ancona; Osp Civile, Padua; Osp Sacco, Milan; Osp Infermi, Rimini; Osp Casa del Sole, Palermo; Osp Civile, Vicenza; OO.RR. di Bergamo; Osp Infermi, Faenza; Osp Riuniti, Parma; Osp Niguarda cà Granda, Milan; Osp Amedeo di Savoia, Turin; Osp L. Sacco, Milan; Osp S. Andrea, La Spezia; Patologia Medica Università, Catania; Università, Cattolica del Sacro Cuore, Rome; Universitá di Sassari; Policlinico Monteluce, Perugia; Osp Galliera, Genoa; Osp S. Maria delle Croci, Ravenna; Osp Maggiore, Novara; Osp S. Maria Maddalena, Trieste; Osp Amedeo di Savoia, Turin; Luxembourg; Centre Hospitalier, Luxembourg; Netherlands; Academisch Ziekenhuis bij de Universitet van Amsterdam; Portugal; Hospital Santa Maria; Hospital Curry Cabral, Lisbon; Spain; Instituto Carlos III, Madrid; Hospital Germans Trias i Pujol, Barcelona; Hospital Clinic I Provincial, Barcelona; Sweden; Karolinska Insitutet, Stockholm; Switzerland; Swiss HIV Cohort Study, Zurich; Centre Hospitalier Universitaire Vaudois, Lausanne; Hospital Cantonal Universitaire de Geneve, Geneva; United Kingdom; UCL Medical School; St Stephen's Clinic, Chelsea and Westminster Hospital; St Mary's Hospital; London
From the Department of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (Drs Lundrgren, Pederson, and Nielsen); Academic Department of Genito-Urinary Medicine, University College of London (England) Medical School (Drs Phillips and Johnson); Division of Infectious Diseases, Saint-Pierre Hospital, Brussels, Belgium (Dr Clumeck); Infectious Disease Unit, Clinic i Provincial, Barcelona, Spain (Dr Gatell); Swiss HIV Cohort Study, Zurich, Switzerland (Dr Ledergerber); and Laboratory of Virology, Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy (Dr Vella).
Footnotes
A complete list of the members in the AIDS in Europe study group appears at the end of this article.
Reprint requests to Coordinating Centre for AIDS in Europe, Department of Infectious Diseases (144), Hvidovre Hospital, University of Copenhagen, DK-2650 Hvidovre, Denmark (Dr Lundgren).
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