A Randomized Blinded Trial To Evaluate the Safety and Tolerance of High Versus Low Dose Zidovudine Administered to Children With Human Immunodeficiency Virus

Inclusion Criteria Concurrent Medication: AMENDED: 03-19-91 Prophylaxis for PCP is recommended according to current practice guidelines. As per published recommendations, primary prophylaxis with TMP / SMX on a M-T-W basis is encouraged. Allowed: Immunoglobulin therapy as single dose exposure prophylaxis or for children with hypogammaglobulinemia. Trimethoprim / sulfamethoxazole (TMP / SMX) and parenteral or aerosolized pentamidine for prophylaxis for Pneumocystis carinii pneumonia for children with AIDS and/or CD4+ counts = or < 500 cells/mm3. Systemic ketoconazole and acyclovir, or oral nystatin for acute therapy. Aerosol ribavirin for short-term treatment of acute respiratory syncytial virus (RSV). AMENDED: 9/17/90 enrollment is limited to children < 6 years of age. Original design: Patients must have the following: Parent or guardian available to give written informed consent. Laboratory evidence of HIV infection. Children < 15 months of age, with CD4+ cell count > 500 cells/mm3, who are thought to have acquired HIV through perinatal transmission and whose only laboratory evidence of HIV infection is a positive antibody test, must also have one or more of the laboratory criteria described in Disease Status AND one or more of the disease criteria that are required of children > 15 months old with CD4+ cell counts > 500 cells/mm3. Prior Medication: Allowed: Aerosol ribavirin. Exclusion Criteria Co-existing Condition: Patients with the following conditions or symptoms are excluded: Previous AIDS-defining opportunistic infection or neoplasms as specified by the CDC surveillance criteria for AIDS. Previous unexplained recurrent, serious bacterial infections (two or more within a 2-year period) including sepsis, meningitis, pneumonia, abscess of an internal organ, and bone/joint infections caused by Haemophilus, Streptococcus, or other pyogenic bacteria. Qualifying for entrance criteria to zidovudine (AZT) + or - gammaglobulin (ACTG 051). Encephalopathy. Failure to thrive (defined as a child who crosses two percentile lines on the growth chart or child who is < fifth percentile and does not follow curve) and/or oral candidiasis for at least 2 months despite appropriate topical therapy. Lymphocytic interstitial pneumonitis (LIP) with steroid dependency or requiring supplemental oxygen. Preexisting malignancies. Concurrent Medication: AMENDED: 03-19-91 Prophylaxis with antiviral or antifungals agents, except for PCP prophylaxis is prohibited. Drugs that are metabolized by hepatic glucuronidation should be used with caution. Excluded: Prophylaxis for oral candidiasis or otitis media or other infections (sinusitis, urinary tract infections). Immunoglobulin therapy not specifically allowed. Ketoconazole, acyclovir, or nystatin for prophylaxis. Drugs that are metabolized by hepatic glucuronidation and might alter metabolism of zidovudine (AZT). Patients with the following are excluded: Previous AIDS-defining opportunistic infection or neoplasms as specified by the CDC surveillance criteria for AIDS. Previous unexplained recurrent, serious bacterial infections (two or more within a 2-year period) including sepsis, meningitis, pneumonia, abscess of an internal organ, and bone/joint infections caused by Haemophilus, Streptococcus, or other pyogenic bacteria. Qualifying for entrance criteria to zidovudine (AZT) + or - gammaglobulin (ACTG 051). Encephalopathy. Failure to thrive (defined as a child who crosses two percentile lines on the growth chart or child who is < fifth percentile and does not follow curve) and/or oral candidiasis for at least 2 months despite appropriate topical therapy. Lymphocytic interstitial pneumonitis (LIP) with steroid dependency or requiring supplemental oxygen. Preexisting malignancies. Prior Medication: Excluded within 2 weeks of study entry: Any other experimental therapy or drugs that cause prolonged neutropenia or significant nephrotoxicity. Excluded within 1 month of study entry: Antiretroviral agents. Immunomodulating agents including immunoglobulin, interferon, isoprinosine, and IL-2. Excluded within 2 months of study entry: Systemic ribavirin for retroviral therapy. Prior Treatment: Excluded within 1 month of study entry: Lymphocyte or red blood cell transfusions. Active alcohol or drug abuse.