Intervention Review

Zidovudine (AZT) versus AZT plus didanosine (ddI) versus AZT plus zalcitabine (ddC) in HIV infected adults

  1. Janet Darbyshire1,*,
  2. Mary Foulkes2,
  3. Richard Peto3,
  4. William Duncan4,
  5. Abdel Babiker1,
  6. Rory Collins5,
  7. Mike Hughes6,
  8. Tim EA Peto7,
  9. Sarah A Walker8

Editorial Group: Cochrane HIV/AIDS Group

Published Online: 17 MAR 2010

Assessed as up-to-date: 5 MAR 2000

DOI: 10.1002/14651858.CD002038

Database Title

Additional Information

How to Cite

Darbyshire J, Foulkes M, Peto R, Duncan W, Babiker A, Collins R, Hughes M, Peto TEA, Walker SA. Zidovudine (AZT) versus AZT plus didanosine (ddI) versus AZT plus zalcitabine (ddC) in HIV infected adults. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD002038. DOI: 10.1002/14651858.CD002038.

Author Information

  1. 1

    London, UK

  2. 2

    FDA/CBER/OCD, Division of Biostatistics and Epidemiology, Rockville, USA

  3. 3

    University of Oxford, Clinical Trial Service and Epidemiological Studies Unit, Oxford, UK

  4. 4

    NIH, Division of AIDS, Therapeutics Research, Bethesda, USA

  5. 5

    ICRF Clinical Trial Service Unit, Oxford, UK

  6. 6

    Harvard School of Public Health, Department of Biostatistics, Boston, USA

  7. 7

    John Radcliffe Hospital, The Nuffield Department of Medicine, Oxford, UK

  8. 8

    MRC Clinical Trials Unit, HIV Division, London, UK

*Janet Darbyshire, MRC Clinical Trials Unit, 222 Euston Road, London, NW1 2DA, UK. j.darbyshire@ctu.mrc.ac.uk.

Publication History

  1. Publication Status: Stable (no update expected for reasons given in 'What's new')
  2. Published Online: 17 MAR 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Zidovudine (AZT) monotherapy was the first antiretroviral drug to be tested widely. The next two drugs to be developed were didanosine (ddI) and zalcitabine (ddC).

Objectives

To assess the effects of zidovudine (AZT), zidovudine plus didanosine (ddI) and zidovudine plus zalcitabine (ddC) on HIV disease progression and survival.

Search methods

Investigators and pharmaceutical companies were contacted, and MEDLINE searches were supplemented by searching conference abstracts.

Selection criteria

Randomised controlled trials comparing any two of AZT plus ddI, AZT plus ddC or AZT alone in participants with or without AIDS which collected information on deaths and new AIDS events.

Data collection and analysis

Individual patient data with, wherever possible, follow-up obtained beyond that previously published were obtained and checked for internal consistency and consistency with any published reports; any apparent discrepancies were resolved with the trialists.
Time to death and to disease progression (defined as a new AIDS-defining event or prior death) were analysed on an intention to treat basis, stratified to avoid direct comparisons between participants in different trials.

Main results

Six trials were included in the meta-analysis. During a median follow-up of 29 months, 2904 individuals progressed, of whom 1850 died. The addition of ddI to AZT delayed both progression (RR 0.74; 95% CI 0.67 to 0.82, P<0.0001) and death (RR 0.72; 95% CI 0.64 to 0.82, P<0.0001). Likewise, the addition of ddC to AZT also delayed progression (RR 0.86; 95% CI 0.78 to 0.94, P=0.001) and death (RR 0.87; 95% CI 0.77 to 0.98, P=0.02). After 3 years the estimated percentages alive and without a new AIDS event were 53% for AZT+ddI, 49% for AZT+ddC and 44% for AZT alone; the percentages alive were 68%, 63% and 59% respectively. Five of the six trials involved randomised comparisons of AZT+ddI versus AZT+ddC: in these, the AZT+ddI regimen had greater effects on disease progression (P=0.004) and death (P=0.009).

Authors' conclusions

The use of ddI and, to a lesser extent, ddC delayed both HIV disease progression and death, at least when added to AZT.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

When used with AZT, ddI and perhaps ddC, can delay HIV disease progression and death

Zidovudine (AZT) was the first antiretroviral drug used in HIV and AIDS. It is expensive and has several adverse effects including nausea, vomiting, blood problems (anaemia and neutropenia) and myopathy (muscle weakness). The next two drugs developed for HIV were didanosine (ddI) and zalcitabine (ddC). The adverse effects of ddI include nausea, vomiting, diarrhoea and problems with the pancreas (pancreatitis) and nerves in the arms and legs (peripheral neuropathy). Adverse effects of ddC are mouth ulcers and peripheral neuropathy. The review of trials found that both HIV disease progression and death are delayed by ddI, and perhaps also by ddC, at least when used with AZT.

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