Journal Article

Neuropsychological Outcome of Zidovudine (AZT) Treatment of Patients with AIDS and AIDS-Related Complex

Drucker, Joan L, Schmitt, Frederick A, McKinnis, Ray, Bigley, Joseph W, Logue, Patrick E, Evans, Randall W

1988

Overview

Two hundred eighty-one patients with the acquired immunodeficiency syndrome (AIDS) or advanced AIDS-related complex were enrolled in a double-blind, placebo-controlled trial of the efficacy and safety of orally administered zidovudine (azidothymidine or AZT). Significant clinical benefits and adverse experiences have been reported from this trial. Because neuropsychiatrie dysfunction is often associated with human immunodeficiency virus (HIV) infection, a brief affective and neuropsychological examination was administered over 16 weeks of the trial to evaluate any changes in neuropsychological function that occurred with drug administration. Patients receiving zidovudine, particularly those with AIDS, showed improved cognition as compared with patients receiving placebo. There were no changes in affective symptoms. The zidovudine recipients also had a statistically significant reduction in the intensity of symptomatic distress during the trial that may account in part for the observed cognitive changes. Some improvement in various cognitive measures was also seen in patients with AIDS-related complex. The results of this study suggest HIV-associated cognitive abnormalities may be partially ameliorated after the administration of zidovudine. (N Engl J Med 1988; 319: 1573–8.) HUMAN immunodeficiency virus (HIV) infection is a progressive, lethal disease that is often accompanied by neurologic disorders, including cognitive changes, progressive dementia, peripheral neuropathy, and paraplegia. 1 Patients who have neurologic symptoms of HIV infection and the acquired immunodeficiency syndrome (AIDS) often have a fairly rapid progression of symptoms 2 and an extremely poor prognosis, with an average survival period of approximately four months. 3 Although some neurologic manifestations of AIDS can result from tumors or opportunistic infection, 4 direct infection of the central nervous system by HIV 5 , 6 may cause the neurologic dysfunction described as AIDS encephalopathy 7 or AIDS dementia complex. 3 Neurologic and neuropsychiatric . . .

• Publisher: Massachusetts Medical Society
• Subject: Acquired immune deficiency syndrome / Acquired Immunodeficiency Syndrome - complications / Acquired Immunodeficiency Syndrome - drug therapy / Acquired Immunodeficiency Syndrome - physiopathology / Affect - drug effects / AIDS / AIDS-related complex / AIDS-Related Complex - complications / AIDS-Related Complex - drug therapy / AIDS-Related Complex - physiopathology / Antiretroviral drugs / Attention - drug effects / Clinical trials / Clinical Trials as Topic / Double-Blind Method / HIV / Human immunodeficiency virus / Humans / Memory - drug effects / Nervous System Diseases - drug therapy / Nervous System Diseases - etiology / Neuropsychology / Oral administration / Patients / Placebos / Psychomotor Performance - drug effects / Statistical analysis / Zidovudine / Zidovudine - adverse effects / Zidovudine - therapeutic use