Dissident AIDS Database

Co-factorsAZT/PIsAIDS symptomsBone marrow suppression
Imminent marketing of AZT raises problems; Marrow suppression hampers AZT use in AIDS victims.
 Kolata, G
  Cytotoxic effects of AZT on the cells of the bone marrow (anemia and immuno-deficiency)
  Science 235, 1462-1463 (1987).1987
Effects of zidovudine in 365 consecutive patients with AIDS or AIDS-related complex.
 Dournon, E., Matheron, S., Rozenbaum, W., et al
  Cytotoxic effects of AZT on the cells of the bone marrow
  Lancet ii, 1297-1302 (1988).1988
The Toxicity of Azidothymidine (AZT) in the Treatment of Patients with AIDS and AIDS-Related-Complex.
 RICHMAN DD, FISCHL MA, GRIECO MH, et al., and The AZT Collaborative Working Group.
  "We conducted a double-blind, placebo-controlled trial of oral azidothymidine (AZT) in 282 patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex. Although significant clinical benefit was documented (N Engl J Med 1987; 317:185-91), serious adverse reactions, particularly bone marrow suppression, were observed. Nausea, myalgia, insomnia, and severe headaches were reported more frequently by recipients of AZT; macrocytosis developed within weeks in most of the AZT group. Anemia with hemoglobin levels below 7.5 g per deciliter developed in 24 percent of AZT recipients and 4 percent of placebo recipients (P less than 0.001). Twenty-one percent of AZT recipients and 4 percent of placebo recipients required multiple red-cell transfusions (P less than 0.001). Neutropenia (less than 500 cells per cubic millimeter) occurred in 16 percent of AZT recipients, as compared with 2 percent of placebo recipients (P less than 0.001). Subjects who entered the study with low CD4 lymphocyte counts, low serum vitamin B12 levels, anemia, or low neutrophil counts were more likely to have hematologic toxic effects. Concurrent use of acetaminophen was also associated with a higher frequency of hematologic toxicity. Although a subset of patients tolerated AZT for an extended period with few toxic effects, the drug should be administered with caution because of its toxicity and the limited experience with it to date."
  NEJM 1987; 317:192-197.1987
Azidothymidine associated with bone marrow failure in the acquired immunodeficiency syndrome (AIDS)
 Gill P S, Rarick M, Byrnes R K, Causey D, Loureiro C and Levine A M
  Four patients with the acquired immunodeficiency syndrome, and a history of Pneumocystis carinii pneumonia developed severe pancytopenia (hemoglobin, less than 85 g/L; granulocytes, less than or equal to 0.5 X 10(9)/L; platelets, less than or equal to 30 X 10(9)/L) 12 to 17 weeks after the initiation of azidothymidine (AZT) therapy. The bone marrow was markedly hypocellular in three patients and moderately hypocellular in the fourth. Partial bone marrow recovery was documented within 4 to 5 weeks in three patients, but no marrow recovery has yet occurred in one patient during the more than 6 months since AZT treatment was discontinued. Azidothymidine should be used cautiously, with close monitoring of blood values.
  Ann. Int. Med. 1987, 107 502–5051987
Zidovudine and bone marrow.
 Mir, N., Costello, C.
  Cytotoxic effects of AZT on the cells of the bone marrow
  Lancet ii, 1195-1196 (1988).1988
Preliminary analysis of the Concorde trial.
 Aboulker, J.-P., Swart, A.M.
  Cytotoxic effects of AZT on the cells of the bone marrow
  Lancet 341, 889-890 (1993).1993
A controlled trial of early versus late treatment with zidovudine in symptomatic human immunodeficiency virus infection.
 Hamilton, J.D., Hartigan, P.M., Simberkoff, M.S., et al
  Cytotoxic effects of AZT on the cells of the bone marrow
  N Engl J Med 326, 437-443 (1992).1992
Adverse drug reactions in patients with HIV infection.
 Ellis CJ, Leung D.
  “The antiretroviral drugs currently licensed in the United Kingdom [June 1996] are zidovudine (azidothymidine [AZT]), zalcitabine (ddC) and didanosine (ddI). All three are nucleoside analogues...All are very toxic. Suppression of bone marrow elements can occur with any of the three.”
  Adverse Drug Reaction Bulletin. 1996 Jun;178:675-8.1996