and trough levels obtained and bone marrow aspirate/biopsy. The dose of Zidovudine will be 
reduced as described above. 
Anemia: Reticulocytopenia develops in up to 40% of AIDS patients on Zidovudine, but is 
less in asymptomatic HIV-1 infected individuals. No dose reduction in Zidovudine is 
recommended for anemia, and patients should be managed with red cell transfusions as 
required. 
Thrombocytopenia: Zidovudine has been infrequently associated with thrombocytopenia. 
Dose reductions will be considered for the development of refractory thrombocytopenia 
persisting after day 100. 
Renal Failure: No dose reductions are necessary for renal insufficiency. 
Dose Escalation of Zidovudine: The dosing of Zidovudine will be escalated for subsequent 
patients by the principal investigator in consultation with Burrough’s Wellcome if HIV-1 
infection is not eradicated in the patients studied initially, provided that lack of engraftment 
has not been observed previously. The maintenance dose will be increased by 50% if HIV-1 
infection persists (after day 90) in two consecutive patients. 
G. Concomitant Medications 
All patients are to receive prophylaxis with intravenous acyclovir as part of BMT 
management. Acyclovir is to be administered at a dose of 500 mg/m 2 IV q 8 hours beginning 
on day -14 and continued until the ANC is > 500/mm 3 . 
Trimethoprim-sulfamethoxazole is to be given as prophylaxis at a dose of 1 DS tab p.o. b.i.d. 
(or IV 5 mg/kg) beginning on day -14 through day -2 and then resumed when there is durable 
engraftment at a dose of 1 DS tab p.o. b.i.d. twice per week until day 180. 
H. Prophylaxis and Management of Herpes Virus Infections 
1 . Herpes simplex: Prophylactic acyclovir should be administered according to standard 
clinical practice beginning pretransplant and stopping when the ANC is > 500/mm 3 . 
The development of herpes simplex virus infections later in the posttransplant period 
may be treated with systemic acyclovir if clinically indicated. Should acyclovir be 
required, 30 cc of heparinized blood must be sent to Room AC 125 prior to starting 
systemic acyclovir and on days 2, 4, 7 and 10 after starting acyclovir. 
2. Herpes zoster: If VZV infection develops, acyclovir therapy is indicated and 30 cc of 
heparinized blood must be drawn prior to initiating therapy and on days 2, 4, 7 and 
10 after starting acyclovir. 
3. Cytomegalovirus Prophylactic ganciclovir should not be administered to patients on 
this protocol. All patients^ will be monitored with weekly viral cultures from the 
blood, urine and throat and with monitoring of CMV-specific CD4 and CD8 + T cell 
responses. Patients with CMV viremia should be treated with ganciclovir according 
to standard clinical practice. Patients with isolated urinary or throat excretion of 
CMV will not be treated with ganciclovir unless they demonstrate absent CMV- 
specific immune responses on the most recent assay. If T cell responses are not 
detectable, ganciclovir should be instituted. In all patients requiring ganciclovir, blood 
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Recombinant DNA Research, Volume 15 
