AZT Proves an Imperfect First Step in AIDS Battle

Mark Starr usually hears it around 10 or 11 a.m. at a Los Angeles AIDS clinic. Chuck Baier hears it sporadically at New York workshops for AIDS patients.

“Everybody has on their little watches,” Baier said. “Periodically through the day you hear, beep-beep-beep.”

Time for somebody to take another dose of AZT.

Every four hours, night and day, thousands of people swallow one or two capsules containing the only federally approved drug for treating acquired immune deficiency syndrome.

It is not an easy therapy. Apart from the four-hour doses, side effects such as nausea, vomiting and anemia make some patients quit AZT and others refuse to try it.

Many doctors say it is too early to define AZT’s long-term benefits and side effects. In recent interviews, AIDS patients on AZT and doctors who prescribe it generally described it as an imperfect stopgap while scientists try to find something better.

But AZT has at least brought hope.

‘I Need a Pill’

“I’ve seen people go from really being disgusted with what’s happening in the medical community around AIDS and saying the only way to deal with the disease is through alternative therapies . . . to changing their ideas to, ‘I need a pill,’ ” said Baier, 33, who has taken AZT since January.

“It’s gone and changed people’s psychology that drastically.”

AZT, or azidothymidine, was approved by the Food and Drug Administration in March. The approval covers treatment only for adults with AIDS or an advanced case of the less severe AIDS-related complex, called ARC, and who in addition have a history of Pneumocystis carinii pneumonia or a low-enough supply of certain white blood cells.

The low blood-cell count indicates an immune system impairment that is the hallmark of AIDS. It leaves the body vulnerable to other, potentially lethal diseases.

AZT is not a cure, but it sabotages reproduction of the virus. In a major study, it helped patients live longer and reduced the number and severity of potentially lethal infections.

But it also produced side effects, including a drop in the number of infection-fighting white blood cells, anemia sometimes bad enough to require transfusions, headaches and nausea.

About 5,000 patients were taking AZT when it was approved by FDA, said Kathy Bartlett, spokeswoman for Burroughs Wellcome Inc., which markets the blue-banded white capsules as Retrovir. More are taking it now, but the exact number is confidential sales information, she said.

The company expects to produce enough for at least 30,000 patients by the end of the year, she said.

AZT’s benefits are hard to assess, not only because it is so new, but also because its effects can be hard to distinguish from the normal waxing and waning of AIDS, doctors say.

Patients ‘Not as Likely to Die’

“It’s not the sort of thing where the patient takes up his bed and walks,” said Dr. John Leedom, chief of infectious diseases at Los Angeles County-USC Medical Center.

At Leedom’s AIDS clinic, his impression so far is that “they get their pneumocystis again but it’s not as bad as we would have expected, and they’re not as likely to die.”

Other practitioners also see encouraging signs. Dr. Michael Roth, a private practitioner in Santa Monica, said 50% to 60% of his 100 patients on AZT feel better and have better appetites.

Dr. Robert Awe, chief of pulmonary medicine at Jefferson Davis Hospital in Houston, has 30 patients on AZT. “By and large they’re doing great,” gaining weight and feeling better, he said.

Not all doctors share that experience. “I’m underwhelmed,” said Dr. Richard Conklin, a Houston physician who said he had seen no objective improvement in his 30 patients. While a few say they feel great, none shows improvement in such measures as number of AIDS-related infections and body weight, he said.

Given such side effects as severe anemia, nausea and vomiting, “I’m just not terribly thrilled with taking a guy who at least at the moment is fairly healthy and working and functioning, giving him a drug that costs him a thousands dollars a month and making him sick,” Conklin said.

Baier, the New York AZT patient, has friends who will not try the drug, preferring to use diet and herbs instead. “They’re not willing to put their bodies through any more pain than it’s already going through,” Baier said.

Blood transfusions are sometimes needed to control AZT-induced anemia. But Starr, the Los Angeles patient, figures his transfusions are worth it.

“It’s a choice between getting a transfusion every couple (of) weeks and surviving, or not having transfusions and succumbing to the opportunistic infections, which are much more severe without AZT and last much longer.

“In a nutshell, for me it’s a real small price to pay.”

Starr, 27, credits AZT with easing his bouts of pneumonia. In his second episode, which occurred before he went on the drug, he was hospitalized for two weeks, running a fever of 106 degrees, and his doctors thought he would die, he said.

When pneumonia struck a third time, he was on the drug. “It was like having a bad cold,” Starr said. “That makes me pretty damned happy. I can recover from a pneumonia like that with no problem.”

A 40-year-old San Francisco patient, who asked to be identified only as Brent, found a more constant improvement.

“I have lots of energy, I feel great. I feel as well as I did before I came down with AIDS,” said Brent, who was diagnosed last August and went on AZT in November.

Gained Weight, Energy

Another San Francisco patient, Peter, 33, said AZT helped him regain 50 pounds and gave him more energy when he first began last December.

Since then his energy level has fallen off, but “as long as I’m not bed-ridden, I’m happy,” he said.

AZT is taken in around-the-clock dosages. Some patients set alarms at night; others have learned to wake up automatically.

Still others are less than religious about taking their night-time capsules. “I used to set alarm clocks, but I don’t anymore. I’m not so dependent on (a strict dose schedule) anymore,” said Jay Hayes, 34, of Dallas.

Doctors took him off AZT for three weeks because of a low white-cell count, and Hayes realized that he would not die if he missed a dose. “It was so nice to sleep more than four hours at a time,” he said.

“I don’t look at this as the great white hope,” Hayes said. It is “one more crutch to lean on. I have all these little crutches: my support group, my workouts in the gym, making sure I eat right, my family. I figure, certainly all of them together are going to help me.”

Others agree that AZT is not the answer.

“I see friends die regularly while they’re on AZT. It doesn’t save anybody’s life,” Starr said.

“It’s the first step in a long stairway we’re slowly building, (to) where there are more drugs available that are more effective and far less toxic.

“I hope it’s obsolete real fast.”