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Ten HTLV-I-associated myelopathy(HAM)patients(four men and six women aged 38 to 58 years)with Expanded Disability Status Scale(EDSS)scores ranging from 4.0 to 8.5 entered an open-label zidovudine study.A high-dosage induction 2 g/d for 4 weeks)was followed by 1 g/d for 20 weeks.Five patients were natives of the Caribbean island Hispaniola,and one each was from Colombia,Cuba,El Salvador,Jamaica,and the United States;all were positive by polymerase chain reaction and nine had positive Western immunoblots for HTLV-1.Side effects included anxiety,insomnia,gastric upset,anorexia,and loss of taste.Preexisting leg cramps were increased in two and headaches in one.Hemoglobin decreased from a mean of 13.5 to 11.8 g/dl and the hematocrit from 40.7%to 34.9%at 8 weeks,and then stabilized. Neutropenia appeared regularly but did not necessitate drug withdrawal. Mean EDSS scores changed little for the group as a whole,but the seven ambulatory patients improved objectively,with their scores dropping from 5.5 to 4.0 and none worsening.Timed gait improved by at least 50%. Following withdrawal,four of the five who had improved regressed. Zidovudine appears to be safe in subjects with HAM who have no other major health problems and should be investigated further. |
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