|Patient accuses Kaiser.|| ||Anonymous.
| ||In 1992, two HIV-free, male homosexuals, erroneously treated with AZT because of a false positive HIV-antibody test, developed fatal AIDS including pneumonia... Their case was described in the Oakland Tribune and in the New York Native because of a malpractice suit against Kaiser Hospital and the manufacturer of AZT, but was not followed up by the media, suggestive of a settlement (299).|
| ||Oakland Tribune 1992; December 1.||1992|
|Risks of immunodeficiency, AIDS, and death related to purity of factor VIII concentrate.|| ||Goedert, J.J.. A.R. Cohen, C.M. Kessler, S. Eichinger, S.V. Seremetis, C.S. Rabkin, EJ. Yellin, P.S. Rosenberg & L.M. Aledort.
| ||The stunning results that HIV-positive hemophiliacs on AZT have 4.5-times more AIDS and have a 2.4-times higher mortality than untreated HIV-positive hemophiliacs, is excused by the NIH researcher James Goedert with the casual explanation, "probably because zidovudine was administered first to those whom clinicians considered to be at highest risk".|
| ||Lancet 1994; 344: 791-792||1994|
|Is AIDS a floating point between HIV seroconversion and death? Insights from the Tricontinental Seroconverter Study.|| ||Van Benthem BHB et al.
| ||“The use of antiretrovirals and PCP prophylaxis before AIDS were associated with a significantly poorer survival after AIDS [median of 16 months before death with antiretrovirals, 25 months without].”|
| ||AIDS. 1998 Jun 18;12(9):1039-1045.||1998|
|Rapid disease progression in human immunodeficiency virus type 1-infected individuals with adverse reactions to trimethoprim-sulfamethoxazole prophylaxis.|| ||Veenstra J et al.
| ||“The use of antiretroviral agents before the start of prophylaxis were also statistically associated with a more rapid progression to AIDS and death”|
| ||Clin Infect Dis. 1997 May;24(5):936-41.||1997|
|Disease progression and early viral dynamics in human immunodeficiency virus-infected children exposed to zidovudine during prenatal and perinatal periods|| ||Kuhn L, Abrams E J, Weedon J, Lambert G, Schoenbaum E E, Nesheim S R, Palumbo P, Vink P E and Bulterys M
| ||Zidovudine (Zdv) is widely used to reduce maternal-infant human immunodeficiency virus transmission (HIV), but its consequences for disease progression among children infected despite Zdv exposure remain unknown. In a multicenter observational cohort study of 325 HIV-infected children born during 1986-1997, clinical progression was compared among infected children exposed or unexposed to Zdv during prenatal and perinatal periods. Zdv exposure was associated with 1.8-fold (95% confidence interval, 1.02-3.11) increased risk of progressing to AIDS or death after adjusting for year of birth, maternal CD4 cell count, maternal AIDS diagnosis, and subsequent antiretroviral therapy of the child. Mean log(10) viral copies at 7-12 weeks were higher among Zdv-exposed children (P=.004). No infected child treated early with multidrug therapy progressed to AIDS or died by 1 year, regardless of early Zdv exposure. More rapid disease progression was observed among infected children exposed during pregnancy or birth to Zdv if effective multidrug therapy was not initiated.|
| ||J. Infect. Dis. 2000, 182 104–111||2000|
|Effect of prenatal zidovudine on disease progression in perinatally HIV-1-infected infants|| ||de Souza R S, Gomez-Marin O, Scott G B, Guasti S, O’Sullivan M J, Oliveira R H and Mitchell C D
| ||To determine the influence of prenatal zidovudine (ZDV) prophylaxis on the course of HIV- 1 infection in children by comparing the clinical outcome of infants born to HIV- 1-seropositive mothers who did versus those who did not receive ZDV during pregnancy. Medical records of HIV-1-seropositive mothers and their infants were reviewed retrospectively. Participants were divided according to maternal ZDV use: no ZDV (n = 152); ZDV (n = 139). The main outcome measure was rapid disease progression (RPD) in the infant, defined as occurrence of a category C disease or AIDS-related death before 18 months of age... Among infected infants, the RPD rate was 29.4% in the no ZDV group compared with 70.6% in the ZDV group (p = .012), and prematurity was significantly associated with a higher risk of RPD (p = .027).|
| ||J. Acquir. Immune Defic. Syndr. 2000, 24 154–161||2000|
|Risk of Progression to AIDS and Death in Women Infected With HIV-1 Initiating Highly Active Antiretroviral Treatment at Different Stages of Disease|| ||Anastos K, Barron Y, Miotti P, Weiser B, Young M, Hessol N, Greenblatt RM, Cohen M, Augenbraun M, Levine A, Munoz A
| ||David Rasnick's comments : The study examined giving HAART to women who were AIDS-free at initiation of HAART compared to giving HAART to women who had AIDS at initiation of HAART. The primary outcomes were "development of a clinical AIDS-defining event and death". About 25% of AIDS-free women were admitted IV drug users, whereas the figure was 36% for the women who already had AIDS at the start. And 84% of both AIDS-free women and women with AIDS at start had a history of anti-HIV drug-use other than HAART. So, almost all women had a history of drug use before entering the study when HAART was added to their drug-burden. "Of the 25 deaths in women with AIDS at HAART initiation, 14 (56%) were unrelated to AIDS and 19 (76%) occurred in women who had not reported an AIDS-defining event before death." Over half of those women died of something other than AIDS. "A history of no exposure to antiretroviral treatment before HAART was not significantly associated with death in women who were AIDS free (RH [relative hazard], 0.78; 95%CI [confidence interval] 0.23-2.61) or who had AIDS (RH, 1.01; 95% CI, 0.53-1.91) at HAART initiation." Another way to look at the results is that lack of antiretroviral treatment did not cause women to get sick and die. In fact, the AIDS-free women at start who never used anti-HIV drugs before the study lived longer than the women who had taken other anti-HIV drugs before entering the study. That's what RH, 0.78, signifies. An RH>1 means greater likelihood of death and RH<1 means less. "[D]elay of treatment until CD4+ cell count falls below 350/mL appears to have clinical benefit at least equal to that conferred by earlier initiation of therapy. On the other hand, women who initiated HAART with CD4+ cell counts less than 200/mL had significantly more rapid progression. ..." In other words, there is no life-saving advantage to initiating HAART early, i.e., at CD4+ cell counts above 350/mL. And importantly, HAART actually accelerates progression to AIDS and death if initiated late, i.e., at CD4+ cell counts less than 200/mL. The authors hold out the hope that if HAART has any benefits at all, it is in a very narrow window of administration somewhere between 200 and 350 CD4+ cells/mL. "Simple and direct comparisons of survival after HAART is initiated at different stages of disease do not suffice to allow conclusions regarding when to start: those who initiate treatment at a later stage had an unmeasured survival benefit before HAART was started. This lead time survival needs to be considered in analysis of data from cohort studies."|
| ||Arch Intern Med 162: 1973-80 (2002)||2002|
|Late presentation of HIV infection associated with prolonged survival following AIDS diagnosis-characteristics of individuals.|| ||Hocking JS et al.
| ||“All AIDS diagnoses from 1992-1998 notified to the Victorian State [Australia] AIDS Registry were included. Subjects were grouped as individuals diagnosed with AIDS within 8 weeks of a first positive HIV test (late presenters), or individuals for whom there was more than 8 weeks between AIDS diagnosis and first positive HIV test (non-late presenters) [this group is more likely to have taken anti-HIV drugs]. Of 1021 AIDS diagnoses notified, 24% were late presenters...Late presenters survived longer following AIDS diagnosis (P <0.0001).”|
| ||International Journal of STD & AIDS. 2000 Aug; 11(8):503-50.||2000|
|Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy.|| ||Hogg et al.
| ||This study followed 1219 people who were started on "antiretroviral" drugs for the first time. They were followed for 3 years, and mortality was compared among people who started with high and low CD4 counts and high and low "viral loads".The remarkable finding from this study was that people initiated on "antiretroviral" therapy with a protease inhibitor had significantly increased risk of death prior to statistical adjustments (RR 2.02). This risk was not as high after adjusting for other variables, but still showed a trend towards increased risk of death (RR 1.44). Similarly, a person who carried a diagnosis of "AIDS" prior to drug initiation had an increased risk of death before adjustment (RR 2.57), but after adjustment this risk was completely eliminated (RR 1.04). To find these numbers in the article one must look at Table 3 on page 2576, as they are not mentioned in the text or in the abstract.The authors explain this result away by saying simply "Subjects who initiated therapy with a protease inhibitor were more likely to die in the univariate analysis, but use of protease inhibitor was based on worst prognosis." (page 2575) They do not offer any evidence supporting this statement except to say that "This is confirmed by the fact that protease inhibitor use was not significant after adjustment." (page 2575) They fail to explain, however, why their "adjustments" still left a trend with 44% increased risk of death (RR 1.44) even after adjusting for variables such as CD4 count, viral load, and diagnosis of AIDS. Although this 44% increase was not statistically significant, it still represents a very unexpected finding if one believes the hype about protease inhibitors.|
| ||JAMA 286(20); 2568-2577.November 28, 2001||2001|
|HIV positive patients first presenting with an AIDS defining illness: characteristics and survival.|| ||Poznansky MC, Coker R, Skinner C, Hill A, Bailey S, Whitaker L, Renton A, Weber J.
| ||“The survival of patients in group B [symptomatic at time of HIV diagnosis] after the onset of AIDS was significantly longer than that of patients in group A [asymptomatic at the time of diagnosis] as determined by Kaplan-Meier log rank analysis (P = 0.0026) [AZT prophylaxis reduced survival from 3 to 2 years => does exposure to antiviral therapy earlier make AIDS worse?]”|
| ||British Medical Journal 1995; 311: 156-158||1995|
|Concorde: MRC/ANRS randomised double-blind controlled trial of immediate and deferred zidovudine in symptom-free HIV infection.|| ||Seligmann M, Warrell DA, Aboulker J-P, Carbon C, Darbyshire JH, Dormont J, Eschwege E, Girling DJ, James DR, Levy J-P, Peto PTA, Schwarz D, Stone AB, Weller IVD, Withnall R, Gelmon K, Lafon E, Swart AM, Aber VR, Babiker AG, Lhoro S, Nunn AJ, Vray M.
| ||The ability of AZT to “delay the progression to AIDS” was investigated in 1994 by the largest, placebo-controlled study of its kind, the British-French Concorde study (Seligmann et al 1994). This study investigated 1749 HIV-positive, mostly male homosexual subjects divided into untreated and AZT-treated subgroups for the onset of AIDS and death. The Concorde study found in 1994 that AZT is unable to prevent AIDS and increases the mortality of recipients by 25%. In view of this it concluded, “The results of Concorde do not encourage the early use of zidovudine (AZT) in symptom-free HIV-infected adults.”|
| ||Lancet 1994; 343: 871-881||1994|