The Dallas Buyers Club Was Right About AZT

I recently sat down in my local cinema to watch Dallas Buyers Club. The film was truly outstanding with amazing performances from Matthew McConaughey as the real-life AIDS patient Ron Woodroof and Jared Leto as the fictional Rayon. The story centres around McConaughey's caricature Ron who believed that a number of unapproved pharmaceutical drugs were helping alleviate his symptoms. He then begins to smuggle these drugs into America and distributes them to his fellow suffered by establishing the Dallas Buyers Club. The reason the film gives as to why Ron has had to go to extreme lengths to survive is that he believes that the drug on offer (AZT also known as Zidovudine) is poisonous and responsible for a lot of death and suffering. Most of the main cast also share Ron's opinions about AZT with the exceptions of the one-dimensional, bland caricatures who are promoting the drug and who also predictably only care about profits and not the well-being of people. The movie really puts AZT in a bad light whilst conversely making Ron out to be a white knight who fights the establishment and offers effective drugs that are not approved by the Food and Drug Administration (FDA). But was the movie correct about AZT?

Dallas Buyers Club AZT

At first glance the movie is completely wrong. AZT is very effective against HIV and works by slowing down the viruses replication allowing people to live longer. It is so effective that it is still used today although alongside with other antivirals to prevent resistance developing. AZT is basically thymidine with an azide group at the 3 position instead of a hydroxyl. It works by selectively inhibiting reverse transcriptase (the enzyme HIV uses to copy its RNA into DNA) by preventing extension onto the 3 position. Like any drug it does have side effects - especially in high doses, as it has been shown to inhibit DNA polymerise (however to a certain extent your body can repair the damage). It can also cause bone marrow toxicity but this is easy to diagnose and can be reversed by lowering the dosage or stopping the drug altogether. 

The problem was that in the eighties no one knew what dose to use to fight the virus. Too little and it would be practically useless, too much and the patient would suffer from unnecessary side effects. Unfortunately at the beginning when no one knew anything about this virus they prescribed too high a dosage and people suffered as a result.

Although the movie spoke about AZT in overwhelmingly negative terms it contradicts itself at the end by saying that AZT went on to save millions of lives as part of HAART (highly active antiretroviral therapy). It also contradicts itself early on when Jennifer Garner’s caricature Dr. Eve Sake changes her mind about AZT. Even though she is distributing flyers warning people against AZT, she decides not to remove her patients off the drug but instead bizarrely in the context of the movie to lower their dose.

Dallas Buyers Club AZT 2

Having said all that, I have a theory that the writers were aware of the effectiveness of AZT and that they put it in the movie for all to see. This theory all revolves around Jared Leto’s character Rayon who we first meet in the hospital after Ron regains consciousness. We found out that he is HIV positive and on a drug trial testing the effectiveness of AZT. At the time he looks healthy and seems to be in good spirits. He’s not underweight nor is he suffering from skin lesions like he is at the end of the movie. He also does not seem to be suffering any adverse side effects from the AZT (although it is possible that he is on the placebo). After beating Ron at poker, Rayon admits that he has been selling half of his AZT to a friend for $5000. As discussed earlier the initial dose of AZT given to the HIV infected people in the trial was too high, and as a result they were suffering from the side effects. It is possible that Rayon accidentally found the ideal dose between effectiveness and side effects, and thus was responding well to the medication. Rayon later comes off the medication (presumably encouraged by Ron) and begins to work at the Dallas Buyers Club. He starts to take the drugs and remedies offered by the club and his health begins to deteriorate. Over the course of the film we see him rapidly lose weight and develop lesions. This all leads up to an emotional scene where Rayon in sat on his bed saying “I don’t wanna die” whilst crying. Rayon is then taken to the hospital by his partner and soon dies of AIDS related illnesses.

But thats just my theory.

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About Myles Power (562 Articles)
My name is Myles Power, and I run the educational YouTube channel, powerm1985. I spend what little free time I have sharing my love of SCIENCE! through home experiments, visiting sites of scientific interest, and angrily ranting at pseudoscience proponents. I am also one of the founding members of the podcast 'The League of Nerds' - which I co-host with James from 'The History of Infection'.

4 Comments on The Dallas Buyers Club Was Right About AZT

  1. I agree with most of your analysis of the movie, and it’s view on AZT. I did want to point out that when rayon is at the Dallas buyers club, she’s also not taking very good care of herself and abusing party drugs, much to Ron’s dismay and his protest. The movie also goes on to show that drugs that Ron takes has side effects like with the scene at the airport. I do wish that the film took a more objective stance, but overall I thought that it was an excellent film and I think it did a good job of portraying the fear and ignorance about HIV and AIDs as well as highlight the problems with access to viable drugs and the cost of obtaining drugs to survive. Many people couldn’t afford these treatments, and I think that this is a problem that still persist in America today.

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  2. The truth about AZT monotherapy for AIDS is that it was a fairly ordinary treatment that had modest, temporary benefits as well as significant side effects, especially when used in the initially approved dose of 1000 – 1200 mg daily. Until 1991 when didanosine (ddI) was licensed, AZT monotherapy was the only effective treatment for AIDS itself, although there were treatments for the opportunistic diseases.

    In reality, the potential risks and fair-to middling benefits of AZT monotherapy in the treatment of AIDS were well-recognised by 1987. What was not properly understood until 1989 was that lower doses were as effective as higher ones, and resulted in significantly fewer side effects.

    Eve Sake’s recommendation in the film to her patients to reduce the dose was not bizarre for the time – patients on AZT were (and still are) routinely monitored for side effects such as bone marrow suppression, and dose reductions or cessation of the drug were standard practice. What physicians didn’t know until dose-response studies had been carried out was whether these reduced doses would still be effective.

    HIV/AIDS denialists distort this history to try to make the argument that AZT rather than HIV caused AIDS. This was a post-hoc addition to Duesberg’s original “AIDS is caused by drugs” hypothesis, which he proposed when it became obvious to everyone that many people with AIDS were not illicit drug users. Duesberg’s claim fails even cursory examination (not the least because even heavy illicit drug users don’t develop AIDS or anything that even looks like AIDS unless they have HIV infection).

    Firstly, AZT did not come on to the market until 1987, and even then it was only approved for use AFTER a diagnosis of AIDS or ARC. It was not approved for use in asymptomatic HIV infection until 1990. High dose AZT was never approved for use by people with asymptomatic HIV infection, although it was used in a number of early trials commencing in the 1980s.
    Secondly, median survival following a diagnosis of AIDS prior to 1987 was only 11 months. Survival with AIDS actually improved in 1987, the year AZT was introduced, and has incrementally improved every year since then. The most dramatic improvements occurred between 1996 and 1998 with the widespread rollout of combination antiretroviral therapy: these early combinations typically included AZT and 3TC with either a protease inhibitor or nevirapine.

    HIV/AIDS denialists try to claim that the marked fall in deaths among people with AIDS from 1996 on compared with 1995 and before was due to a reduction in the dose of AZT used in the new combination regimens. This is a flat-out lie. The approved dose of AZT for ongoing therapy was changed to 500 – 600 mg daily in January 1990, and this was the standard dose used throughout the 1990s whether in combination therapy (after 1995) or in the less effective monotherapy (between 1990-1995).

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  3. This is a biased BS damage control piece in favor of the diabolic lab WELCOME, who produced this drug. AZT and the FDA are in this great damage made to humanity together!

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  4. I want to say a special thanks to Dr ODIA for helping,….I and my daughter get cured from HIV disease. God will continue to bless you more abundantly for the good work you are doing in the life of people. I will keep on writing and posting testimonies about you on the Internet,i was an HIV patient for many years, i saw a testimony on how Dr ODIA cured people, i did not believe that he could cure me from HIV. I gave him a test by contacting him and i and my daughter was cured. Dr ODIA, God will continue to bless you. kindly contact him today through his Email: (drodiaherbalistcenter @ gmail . com ) Or Call +2347032130627. He is always able to help you get your heart desire granted…

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