A Phase I/II Open Label Study To Evaluate the Antiviral Potential of Combination Low-Dose Therapy With Zidovudine and Interferon-Alpha 2A in Patients With Symptomatic HIV Disease

To evaluate the anti-HIV effect of single agent versus combination therapy with zidovudine (AZT) and interferon alfa-2a (IFN-A2a), as measured by p24 protein expression, viral growth and infectivity in patients with symptomatic HIV disease. To assess the safety of low dose schedules of AZT and IFN-A2a, alone and in combination, as measured by neutrophil counts and hepatic transaminase levels. To evaluate the comparative effects of single agent versus combination therapy with AZT and IFN-A2a on CD4 cell counts and skin test reactivity. AZT is known to be an effective treatment for HIV infection. However, patients may develop reactions to AZT when it is administered for long periods of time. Combining AZT with another drug at lower doses might reduce toxicity in patients and prevent the development of drug resistant strains. IFN-A2a can reduce the growth of HIV in test tube experiments and recent studies have shown that when AZT and IFN-A2a are used together they reduce the growth of HIV more effectively than when either drug is used alone. This study will examine the effectiveness and safety of these drugs when they are given together and compare these results with the effectiveness and safety of the drugs when they are used alone.

AZT is known to be an effective treatment for HIV infection. However, patients may develop reactions to AZT when it is administered for long periods of time. Combining AZT with another drug at lower doses might reduce toxicity in patients and prevent the development of drug resistant strains. IFN-A2a can reduce the growth of HIV in test tube experiments and recent studies have shown that when AZT and IFN-A2a are used together they reduce the growth of HIV more effectively than when either drug is used alone. This study will examine the effectiveness and safety of these drugs when they are given together and compare these results with the effectiveness and safety of the drugs when they are used alone. AMENDED: 04-18-91 Treatment extended to 96 weeks. Patients are seen weekly for the first month and for the month following initiation of combination therapy (Cohorts 1, 2), then every other week until treatment week 48, followed by every week for the duration of the study. AMENDED: The doses have been modified to one of 4 total daily doses of AZT and one of 4 daily doses of IFN-A2a. AMENDED: Total treatment period will be 48 weeks. AMENDED: 9-24-90 Treatment will end 901214. Original Design: Before beginning any treatment, patients are carefully examined and evaluated. Each patient receives medication for 24 weeks, followed by a 4-week follow-up period. Patients are assigned randomly to one of four dosing schedules within one of three groups stratified according to whether or not they have ever received AZT and / or IFN-A2a: * Group 1 receives AZT alone for 12 weeks, then AZT plus IFN-A2a for the following 12 weeks. * Group 2 receives IFN-A2a alone for 12 weeks, then IFN-A2a plus AZT for the following 12 weeks. * Group 3 receives the combination of AZT and IFN-A2a for 24 weeks. Medications are administered according to one of four possible daily dosing schedules of AZT plus IFN-A2a (increasing doses of each). AZT is taken by mouth as a capsule every 6 hours. IFN-A2a is given by an injection under the skin once a day. Initially, doses of IFN-A2a are given by one of the research staff, after which patients are taught to give their own injections. Patients are examined weekly for the first 4 weeks, then every other week until the end of the study. Patients assigned to groups receiving two drugs will be examined weekly again for 4 weeks when the second drug is added.