ddodell@stjhmc.fidonet.org (David Dodell) (04/06/91)
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J O H N J A M E S writes on A I D S
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copyright 1990 by John S. James;
permission granted for non-commercial use.
AIDS TREATMENT NEWS Issue #123, March 15, 1991
phone 800/TREAT-1-2, or 415/255-0588
Contents: [items are separated by "*****" for this display]
Toxoplasmosis: 566C80 Study Opens in Seven Cities
ddC: Developer Speeds FDA Application
Pneumocystis Prophylaxis: Study Suggests Lower Bactrim Dose
Pneumocystis Prophylaxis in Children: New Guidelines
AIDS Agency Raided in Orlando; AZT Seized
Labor Unions Champion Insurance, Care for HIV
Thymopentin: Promising Immunomodulator
New FDA Commissioner Testifies on AIDS Drugs
Announcements:
National AIDS Update Conference;
Boston Conference on Women and AIDS;
Seattle Treatment Education Project New
Address, Dance Benefit
***** Toxoplasmosis: 566C80 Study Opens in Seven Cities
by Michelle Roland
A pilot study of the experimental compound 566C80 in
patients with toxoplasmosis who have failed or who are intolerant
to standard therapy has recently opened at eight sites in seven
U. S. cities (see list below). 566C80 has wide spectrum anti-
protozoal activity, and is being tested against pneumocystis as
well as against toxoplasmosis. (For more information about the
drug, see "Pneumocystis Prophylaxis Overview," AIDS TREATMENT
NEWS #114, November 2, 1990.) This article is based on our
interview with the study coordinator at San Francisco General
Hospital; we have not called the other sites.
According to SFGH research coordinator Rebecca Coleman,
Pharm. D., this trial is essentially a mechanism for
compassionate access for people who have failed standard
treatment with pyrimethamine and sulfadiazine. Dr. Coleman
stated that each patient will be considered individually under
the inclusion and exclusion criteria, especially concerning
presence of other active infections requiring medication.
566C80 is an oral drug; it will be administered for a total
of 42 days. The study requires all patients to be hospitalized
for at least four days; then they will be followed as outpatients
weekly for two weeks, every two weeks for a month, and then
monthly for a total of six months. Patients who respond to
treatment may be eligible to receive maintenance doses of 566C80
indefinitely. According to Dr. Coleman, the company is committed
to ongoing access but has not yet received FDA approval for such
a program. She explained that the FDA is expected to grant
incremental approvals -- perhaps for several months at a time --
to supply the drug when necessary, after the conclusion of the
study.
To be eligible for the trial, patients must have a positive
diagnosis of toxoplasmosis and no evidence of any other infection
or cancer of brain tissue. Patients who appear to have failed
standard treatment will be required to have a brain biopsy.
Symptoms of toxoplasmosis must not have improved after at least
21 days of standard therapy, or must have progressed after at
least 14 days of treatment. Patients intolerant to standard
therapy may also qualify for this trial. They will not be
required to have a brain biopsy if other diagnostic tests suggest
toxoplasmosis.
Patients must be at least 13 years old, and women must have
a negative pregnancy test. During the first three weeks of
treatment, neither AZT, ddI, ddC, Bactrim, dapsone, clindamycin,
nor any experimental treatment will be allowed.
The drug will be provided by Burroughs-Wellcome, but all
other costs will be the responsibility of the patient. To
facilitate reimbursement by third party payers, the diagnostic
tests and frequency of clinic visits have been established to
reflect standard care practices. The staff at SFGH will work
with each patient and referring physician to receive prior
authorization of coverage from third party payers.
Trial Sites and Physicians
Physicians with a patient to enroll should contact one of
the following physicians. According to a representative of
Burroughs-Wellcome, these sites are open; however, we were unable
to call by press time to confirm that each is ready. Additional
sites are expected to open in the future. This trial is not yet
listed with the AIDS Clinical Trials Information Service
(800/TRIALS-A).
San Francisco (2 sites): San Francisco General Hospital, John
Stansell, M. D., 415/821-8313; Ralph K. Davies Hospital, Gifford
Leong, M. D.
Oakland: Merritt-Peralta Medical Center, Patrick Joseph, M. D.
Los Angeles: Los Angeles County/USC Medical Center, Fred
Sattler, M. D.
Portland: Oregon AIDS Task Force/Research and Education Group,
Jim Sampson, M. D.
New York: Harlem Hospital, Wafaa El Sadr, M. D.
Baltimore: Johns Hopkins Hospital, Judith Feinberg, M. D.
Durham: Duke University Medical Center, Hetty Waskin, M. D.
***** ddC: Developer Speeds FDA Application
by John S. James
Hoffmann-La Roche, the developer of the anti-HIV drug ddC,
has arranged with the U. S. Food and Drug Administration to
submit its New Drug Application (NDA) for that drug in sections
as they are ready, for stepwise review by the FDA, instead of the
usual procedure of waiting until the whole NDA is finished. The
company estimates that the submission process should be completed
by midyear. In addition, Hoffmann-La Roche will seek marketing
approval for ddC in combination with AZT, as well as approval for
use of ddC alone as an alternative to AZT. These efforts to speed
the approval are important for several reasons:
* Each NDA is a large document, with many volumes of
paperwork; it is submitted by one large organization (a
pharmaceutical company) for evaluation by another (the FDA). In
any such procedure, the differences in corporate culture between
the organizations, as well as the effects of staff turnover, will
invariably lead to points of friction, requiring sometimes
lengthy negotiations to resolve. This organizational dynamic
alone can lead to major delays in drug approval, quite aside from
any substantive scientific, medical, or policy questions.
Submitting the NDA in sections allows early issues to be
addressed immediately, and later frictions to be reduced as the
individuals involved develop working relationships.
* The FDA has traditionally leaned strongly toward first
evaluating a drug by itself, and considering combinations only
after efficacy has been shown for the drug alone. ddC, however,
is showing unexpectedly good results in combination with AZT, in
a small study. (See AIDS TREATMENT NEWS #115, November 23, 1990,
for early news about this combination. The study results have
not yet been formally published.) If Hoffmann-La Roche had not
applied for combination approval at this time, then the
combination data would have been irrelevant to the FDA's
evaluation of the NDA, and the drug would have been judged
without this strong support.
* AIDS treatment activists had also feared that ddC approval
would be delayed by the serious staff shortages at the FDA --
that the Agency could not afford to assign people to evaluate the
NDA for ddC until the NDA for ddI was finished. The staff
shortages are very much a problem; but at least the wait behind
ddI seems unlikely to happen with ddC.
There are still concerns about how much if any of the data
from the major controlled trials now ongoing can be used in the
current evaluation of ddC (and also ddI). Some experts fear that
using the data being generated by these trials, before the trials
have ended, might bias the studies or even lead to their
discontinuation. The existing studies are automatically reviewed
anyway, by a Data Safety Monitoring Board (DSMB); however, the
DSMB operates secretly, even from the FDA, and it only looks for
extreme differences between the study drugs, differences which
would make it unethical to continue the study. For drug
approval, the question is not whether the new drug is very
different from an already-approved therapy, or even whether the
two are equivalent; instead, the key question is whether the new
drug has efficacy and value as a treatment. We are concerned
that ddC (and ddI) may be evaluated without considering all of
the important existing data. We do not know how this complex
issue will be resolved.
***** Pneumocystis Prophylaxis: Study Suggests Lower Bactrim
Dose
A study of hospital records, published February 23, 1991, in
The Lancet, has suggested that low-dose co-trimoxazole (also
called Bactrim, Septra, sulfamethoxazole-trimethoprim, etc. --
there are many different names for this drug) was more effective
than aerosol pentamidine for preventing pneumocystis, may also
help prevent toxoplasmosis, and had fewer side effects than the
larger Bactrim doses used in other studies to prevent
pneumocystis. And the cost of this form of pneumocystis
prophylaxis, when generic versions of the drug are used, is about
a hundred times less than the cost of aerosol pentamidine; the
drug can cost about $10 per year, making this therapy potentially
available to everyone.
The patients studied were members of Kaiser Permanente
Medical Care Program in Los Angeles. Since Kaiser patients
usually get all their care from Kaiser clinics and hospitals, and
obtain their prescriptions from Kaiser pharmacies, uniform
records of visits and prescriptions were available. 116 patients
met all the criteria for this study: consecutive prescriptions
for co-trimoxazole between December 1986 and June 1988, symptoms
of immune deficiency, a diagnosis of AIDS or ARC, and either
previous pneumocystis and/or T-helper count under 200. All
records were reviewed until June 1990, or until the patients
died; no one was lost to followup. The co-trimoxazole dose used
by these 116 patients was one DS (double strength) tablet every
Monday, Wednesday, and Friday.
No patient had pneumocystis while on this treatment. Of the
116 patients in the study, 71 had previously had pneumocystis,
and they were followed on the prophylaxis for an average of 18.5
months. Those who had not had pneumocystis previously were
followed for an average of 24.2 months. By contrast, without
prophylaxis, half of the patients who have had pneumocystis would
be expected to relapse within eight months, according to
published data from other studies; and more than half of
symptomatic patients with T-helper counts less than 200, but who
have never had pneumocystis, would probably develop the disease
within 24 months.
These results were better than those with aerosol
pentamidine. The same Kaiser center found that 10 percent of
patients who had previously had pneumocystis relapsed within one
year, despite 300 mg of aerosolized pentamidine once per month.
Also, there were no cases of toxoplasmosis among the 116
patients treated with the low-dose co-trimoxazole. There were
cases of the disease among those treated with aerosol pentamidine
(which could have no effect on toxoplasmosis, because very little
of the drug leaves the lungs). However, there were not enough
cases to show for sure that co-trimoxazole was preventing the
disease; the fact that no one developed toxoplasmosis might have
been a result of the therapy, or it might have been coincidence.
Side effects believed due to co-trimoxazole -- especially
rash, fever, and nausea -- occurred in 28 percent of the 116
patients. But only in nine percent (of the 116) were they severe
enough to require permanently stopping the drug. (In some other
cases, the co-trimoxazole was stopped for seven to ten days, and
then could be restarted.) Side effects almost always began within
the first month if they occurred at all. In no case were they
life-threatening or otherwise very severe.
***** Pneumocystis Prophylaxis in Children: New Guidelines
by Michelle Roland
Because the immune systems of children and infants are very
different from those of adults, HIV infection often manifests
itself uniquely in these populations. Therefore, standard
treatment and prophylaxis guidelines in adults often have little
relevance for infants and children. Clinicians and parents of
HIV-infected children know that these children develop
pneumocystis long before their T-helper counts have declined to
the usual adult threshold of 200 to 300. However, almost no data
exist on T-helper counts in healthy, non-HIV-infected infants and
children, let alone in those with HIV infection.
A working group convened at the National Pediatric HIV
Research Center at Children's Hospital in New Jersey has reviewed
a series of studies of the natural history, treatment, and
prevention of pneumocystis in infants and children. Their
recommendations for pneumocystis prophylaxis are being published
by the U. S. Centers for Disease Control in the March 15
Morbidity and Mortality Weekly Report (MMWR). The full text will
be reprinted in the Journal of the American Medical Association
(JAMA) on April 3. Copies can be obtained from the National AIDS
Information Clearinghouse by calling 800/458-5231 after about
mid-April.
Pneumocystis is a common opportunistic infection in infants
with HIV. Ninety percent of young children with pneumocystis have
had T-helper counts below 1500. Infants without HIV infection may
have normal T-helper counts around 3,000 and as high as 5,000 --
far higher than adult values; as they grow older, the counts
decline to adult values. In contrast, the T-helper percentage
values are comparable between children and adults. The new
recommendations take these differences into account.
Although these recommendations are a vital step toward
improving the standards of health care available to infants and
children, advocates for children with HIV have noted that the
AIDS Clinical Trials Group (ACTG), the government-sponsored
clinical trials system, is conducting little research on
preventing and treating opportunistic infections in children.
Understanding these illnesses, and testing agents to prevent and
treat them, must become higher priorities in the immediate
future.
***** AIDS Agency Raided in Orlando; AZT Seized
by John S. James
On March 7 the Florida Department of Law Enforcement (FDLE)
raided the Orlando, Florida, office of Trans-Aid and the home of
its founder and director, Alfredo Martinez-Garcia. AZT and other
medications were seized. No criminal charges have been filed. In
the week after the raid, the Florida AIDS Legal Defense and
Education Fund received 75 calls, mostly from AIDS service
organizations and PWA groups afraid that they, too, might be
raided.
Background
Alfredo Martinez-Garcia started Trans-Aid Support Services,
Inc. in March 1988 after his lover died of AIDS. Alfredo, as he
is commonly known, is well known in the Orlando area and
elsewhere for his AIDS service work.
The target of the raid appears to be the widespread practice
of giving away unused expensive medications left by someone who
has died, or by someone who has decided to discontinue use of
medicines they have purchased, to other patients who have
prescriptions for the drugs but are unable to afford them. It is
usually illegal for anyone except certain medical professionals
to distribute prescription drugs, even by giving them away
without charge. Until now, however, law enforcement authorities
have not sought out such cases. The Orlando raid has raised
fears that this policy might be changing -- possibly under
pressure of an AIDS hysteria in Florida which started after it
was learned that a dentist there may have transmitted HIV to
patients.
According to an affidavit by the FDLE on which the search
warrant was based, the Florida investigation of Trans-Aid goes
back at least to July 1989; it was apparently begun by the
Inspector General's office of Florida's Health and Rehabilitative
Services. By January 1991 the FDLE had become involved. Agents
with electronic monitoring visited Trans-Aid, and an informant
posing as a person with AIDS, and using a fictitious file of
blood-test results, began calling Alfredo and asking for drugs.
According to law-enforcement officials quoted in the Orlando
Sentinel, the informant received AZT twice and another drug once
during the three-month investigation by FDLE.
Comment
The Florida Legal Defense and Education Fund has scheduled a
March 19 meeting in Tallahassee between State officials and AIDS
service organizations. Almost all AIDS organizations have
clients who obtain AZT through friends or through patients'
networks because they could not afford the drug otherwise. There
are widespread fears that trying to police this activity would
damage the bonds between State agencies, non-government agencies,
and patients -- as well as raising class and access issues, and
wasting resources needed elsewhere. Many feel that with the
health-care system desperately needing reform, self-help efforts
like Trans-Aid should be encouraged, not squelched.
In the current case, there is some question among lawyers
and others involved as to whether it would be best to organize a
high-profile public defense of Alfredo and Trans-Aid, or to focus
on a low-key effort to develop a compromise -- for example, an
arrangement for a physician to visit Trans-Aid periodically to
distribute free drugs to patients with prescriptions for them.
One physician has already volunteered to do so.
Certainly Alfredo and Trans-Aid deserve community support.
For at least three years Alfredo has dedicated his life to
serving the AIDS community, so he should have our support when he
needs it. Also, it is important to establish that a legitimate
AIDS organization will receive an effective legal defense, and
public defense if appropriate. To avoid the development of
politically motivated prosecutions, officials must know that
forays against such groups will be difficult, expensive,
unpopular, and unprofitable. We hope this case will be settled
quickly, however, without the need for a national cause celebre,
which would consume community resources which could better be
focused elsewhere.
Trans-Aid does need money for legal defense; how much is
needed depends on whether criminal charges are filed. Alfredo
cannot personally afford the legal assistance needed even to seek
return of his personal prescriptions, which were seized with the
other medications.
Persons who want to contribute can send a check to Trans-
Aid, 4618 Canna Drive, Orlando, FL 32809; Trans-Aid is a non-
profit organization. Because future needs are uncertain, persons
may want to call Alfredo first, to be better informed about the
current situation. He can be reached at Trans-Aid, 407/839-0945
(day), or 407/352-2352 (evenings).
***** Labor Unions Champion Insurance, Care For HIV
by Denny Smith
Two San Francisco labor unions have implemented HIV care
programs which could serve as models for other organizations.
The programs concern insurance coverage for HIV treatments, and a
long-term union effort to improve HIV care at a major medical
center.
Restaurant Workers Win HIV Coverage
Local 2 of the San Francisco Hotel Employees and Restaurant
Employees Union has become the first trade union in the U. S. to
acquire and fulfill a health benefits contract which includes
substantial and explicit coverage for members with AIDS/HIV-
related expenses.
The contract language specifying the coverage was won over a
year ago by the 12,000 unionized workers in the City's pivotal
hotel and restaurant industry. However, the benefits became
available only recently, after the first employer contribution
was made in November of 1990.
The Local 2 fund will reimburse for experimental as well as
prescription drugs, co-insurance payments and deductibles, lab
work, homecare, non-disposable medical equipment, and even non-
medical expenses such as food, rent, utilities, and
transportation. Coverage is provided by a special fund created
from monthly, progressive contributions from employers, and will
compensate for any legitimate health care refused reimbursement
by the employee's regular insurer.
We spoke to Jack Gribbon, who works for the Local and who
designed the care package. He is familiar with the specific
difficulties in negotiating health benefits for his members, and
for union contracts in general. Antagonisms over health coverage
were integral to four of every five labor disputes in this
country in 1989.
Mr. Gribbon said that in spite of the model language of his
union's contract, many people with HIV continue to be
marginalized or ignored in health care benefits negotiations. He
shared with us an anecdote typifying inadequate HIV coverage in
union contracts, from last year's conference of the International
Foundation of Employee Benefits. These annual conferences are
attended by trustees representing business, labor, and community
service agencies. When the dilemma of how to cover HIV infection
as a pre-existing condition came up for discussion, someone
suggested that HIV simply become a basis for complete exclusion
from insurance coverage. Mr. Gribbon, together with allies at
the conference, strongly protested and proposed the exact
opposite: that people with HIV or AIDS be able to expect the
same comprehensive coverage afforded their co-workers. Mr.
Gribbon would like to see other employers and unions use the
Local 2 fund to negotiate the language of their own health care
contracts.
Hospital Workers Take Stand For Patient Care
Local 250, Hospital and Institutional Workers Union of the
Service Employees International Union (SEIU), has fought for over
five years for the needs of members with HIV, for workplace
safety, and for the patients served by the Local. This fight has
been waged through the Local's "AIDS Education Committee," which
is open to participation from any union member and has enjoyed
strong backing from both local and national SEIU leadership. The
committee's "Train the Trainer" programs have helped Local
members distinguish between real risks for exposure to HIV and
irrational fears, and to respect the rights of patients while
assuring the safety of caregivers.
The first achievement of Local 250's AIDS Education
Committee was the creation of an inpatient AIDS ward at Kaiser
Hospital in San Francisco, a development which greatly improved
the medical care for patients there. Previously, Kaiser patients
hospitalized with AIDS-related complications often experienced
inconsistent care, marred by inexperience with treating HIV on
the part of some attending physicians and by fears of "catching"
AIDS on the part of some hospital staff.
Kaiser-Permanente is a health maintenance organization (HMO)
with clinics and medical centers throughout California and, to a
lesser degree, several other states. HMOs operate as a combined
health insurer and health-care provider; they are expanding in
the United States. This writer was employed at the San Francisco
Kaiser facility in 1986, a year before joining the staff of AIDS
TREATMENT NEWS. When dissatisfaction with the care of persons
with AIDS became a serious issue, we met with several co-workers
to enlist the support of our union, of the San Francisco Human
Rights Commission, and of sympathetic Kaiser doctors, nurses, and
technicians, to effect a change in Kaiser's AIDS care.
A series of negotiations with the hospital administration
led to an acknowledgement that the problems were unacceptable.
Plans were developed for a ten-bed ward devoted exclusively to
caring for patients with AIDS, and the ward was to be staffed by
caregivers fluent in the latest standards of AIDS treatments.
Kaiser implemented the plan in good faith, with input from
the union and from employee representatives. A comprehensive
AIDS-care orientation was provided to everyone who volunteered to
work on the ward. We have since heard generally good reports of
the ward from the San Francisco PWA community. Kaiser's
outpatient care has not always shared this response. In fact,
repeated negotiations between Kaiser and a community activist
group called KPAU (Kaiser Patient Advocacy Union) produced less
progress and more friction on both sides than did the earlier
situation. We plan c
report on the status and goals of Kaiser,
and of KPAU, in a future article.
***** Thymopentin: Promising Immunomodulator
by Denny Smith
Thymopentin, also known as TP-5, is a synthesized derivative
of thymopoietin, a naturally occurring hormone responsible for
inducing T-cell precursors to differentiate and mature. A study
at the Istituto di Patologia Medica in Bari, Italy, reported
thymopentin-related increases in T4 cells and some improvement
in symptoms for 21 people. Two studies of thymopentin published
at the Sixth International Conference on AIDS pointed to
stabilization of T-helper counts and p24 antigenemia in
asymptomatic and mildly symptomatic patients during treatment
with thymopentin. One of the studies was too small to see
differences in disease progression. In the larger study, none of
the treated patients progressed to symptoms, compared to four of
the placebo patients who did progress. No side effects were
attributed to thymopentin (Abstracts #S. B. 484 and S. B. 485).
We spoke to Kathy Labriola, L. V. N., who managed a third
thymopentin trial for Marcus Conant, M. D., a well-known San
Francisco physician and researcher. Ms. Labriola shared the
preliminary results of this trial, which was concluded last July
but has not yet finished a statistical analysis. The study
enrolled 100 asymptomatic participants and lasted one year. No
other HIV drugs were used, except that for six months of the
study, ten people were taking AZT. Participants receiving active
drug were given 50 mg once a week. (In the previous studies of
thymopentin, the same dose was given three times a week.)
When the trends of symptom development were identified,
thymopentin clearly showed some protective benefits. Of those
participants getting a placebo, 21 developed some observable
symptoms, compared to only 13 receiving thymopentin. Nobody who
received the drug in the study progressed to AIDS, but two who
were in the placebo group did. In addition, four in the placebo
group developed serious cases of herpes zoster, or shingles, two
experienced outbreaks of genital warts, and eight were troubled
by fungal skin infections. In the treatment group, four people
noticed skin infections, but none experienced shingles or warts.
Serologic markers were not as descriptive. The placebo
group experienced a slightly sharper decline in average T4-helper
cell counts, and the ratio of T4 to T8 cells, than did the
treatment group. However, two participants receiving thymopentin
became mildly positive for p24 antigenemia, while everyone on
placebo remained antigen-negative.
Dr. Conant is now recruiting for a trial of thymopentin
combined with AZT. The number for more information is 415/923-
0555.
Several other thymus preparations have been under study in
AIDS research as possible immunomodulators. These include
thymosin, thymostimulin, thymomodulin, thymic humoral factor,
calf thymus lysate, and thymus implants. We will report any
significant news of these agents as they develop.
References
Thompson, S E and others. Effects of thymopentin on disease
progression and surrogate markers in HIV infection-A one year
study. Abstract #S. B. 484, Sixth International Conference on
AIDS, San Francisco, June 20-24, 1990.
Conant, M and others. Twenty-four week double blind evaluation
of thymopentin treatment on disease progression in HIV infected
patients. Abstract # 485, Sixth International Conference on
AIDS, San Francisco, June 20, 1990.
***** New FDA Commissioner Testifies on AIDS Drugs
On March 6 the new FDA Commissioner David Kessler, M. D.,
told Senator Edward Kennedy's Labor and Human Resources Committee
that the FDA would not obstruct drugs for AIDS or other life-
threatening diseases. According to reporter Nick Bartolomeo of
the gay newspaper The Washington Blade, Dr. Kessler told the
Committee that the FDA had more than 350 applications for testing
new AIDS drugs and other treatments -- which Dr. Kessler
described as "the pipeline of things to come." Dr. Kessler also
said that "if the mission [of the FDA] is to protect public
health, the Agency has an obligation to reach for the data. We
can't sit back passively." A short article on the hearing
appeared in the Blade on March 15.
Dr. Kessler also discussed conditional approval, a proposal
to allow earlier drug approval on condition that the developer
continue scientific testing. (Note: such agreements have been
made in the past, but often broken by the developer. New
legislation might be needed for conditional approval, since at
present it is not clear that the FDA has the authority to enforce
such agreements.)
An article on the hearing in the March 17 San Francisco
Examiner mentioned the testimony on avoiding delays in approval
of important new drugs. The Examiner article focused primarily
on Kessler's call for stronger enforcement to prevent abuses such
as fraudulent data submitted for generic drugs, or misleading
drug claims in advertisements directed to the public.
***** Announcements
** National AIDS Update Conference, May 19-22
The 4th National AIDS Update Conference will take place May
19-22 at the San Francisco Civic Auditorium. This program is
designed for "health care providers, community-based and HIV/AIDS
service organizations, social service providers, mental health
care providers, local public health agencies, hospital planning
and service providers, elected and non-elected community leaders,
state and local government representatives, and individuals with
HIV infection." Sponsors include the American Foundation for
AIDS Research (AmFAR), American Medical Association, U. S.
Centers for Disease Control, National Association of Persons With
AIDS, San Francisco Department of Public Health, U. S. Public
Health Service Health Resources and Services Administration, and
the University of California San Francisco Institute for Health
Policy Studies. The conference is organized into four tracks:
Care and Services, Education and Prevention, Policy and
Administration, and Treatment.
The regular registration fee is $145 ($195 after April 5),
plus $25 for continuing education credit. Registration for
persons with AIDS or ARC is $50 ($75 after April 5). Booths,
display tables, book or literature displays, and the conference's
film festival for showing videos are available for companies and
for non-profit organizations. For more information or for
registration forms, call, fax, or write to: AIDS Conference
Registrar, c/o KREBS Convention Management Services, 555 DeHaro
Street, Suite 200, San Francisco, CA 94107-2348, phone 415/255-
1297, fax 415/255-8496.
** Boston: Health Fair, Conference on Women and AIDS
The Fenway Community Health Center and the Boston AIDS
Consortium are co-sponsoring a conference on women and AIDS,
April 19-21, at the Westin Hotel at Copley Place. A concurrent
women's health fair is planned for Saturday and Sunday, April 20
and 21.
The deadline for registration is April 1, and some
scholarships are available for women with HIV and persons with
limited income. For information, interested persons should call
617/267-0900, or contact the Fenway Community Health Center, 7
Havilan St., Boston, MA, 02115.
** Seattle Treatment Education Project:
New Address, Dance Benefit
In issue #121, AIDS TREATMENT NEWS included the Seattle
Treatment Education Project (STEP) Perspective newsletter in a
list of periodicals recommended for HIV Treatment libraries. The
new address for STEP is 127 Broadway E., Suite E, Seattle, WA,
98102.
STEP will be holding a benefit dance on Friday, April 5,
from 6 to 10 p.m. at Hamburger Mary's. For ticket information,
interested persons can call 206/329-4857.
***** Statement of Purpose
AIDS TREATMENT NEWS reports on experimental and
complementary treatments, especially those available now. It
collects information from medical journals, and from interviews
with scientists, physicians, and other health practitioners, and
persons with AIDS or HIV.
Long-term survivors have usually tried many different
treatments, and found combinations which work for them. AIDS
TREATMENT NEWS does not recommend particular therapies, but seeks
to increase the options available.
We also examine the ethical and public-policy issues around
AIDS treatment research and treatment access.
***** How to Subscribe to AIDS TREATMENT NEWS by mail
Send $100 per year for 24 issues ($100 for nonprofit
organizations, $200 for businesses and institutions), or $40
reduced rate for persons with AIDS or related conditions who
cannot afford the regular rate, to: ATN Publications, P. O. Box
411256, San Francisco, CA 94141. A six-month subscription (12
issues) is $55 for individuals or nonprofits, $110 for businesses
and institutions, or $20 reduced rate. For subscription
information and a sample issue, call 800/TREAT-12 (800/873-2812),
or 415/255-0588.
To order back issues, send $18 for issues #1 through #75,
plus the per-issue cost for each later issue you need. The per-
issue cost is $1 reduced rate, $2 individual or nonprofit rate,
and $4 for businesses and institutions (Note that issues 1
through 75 are also available through bookstores, at a retail
price of $12.95 .) The back issues include articles on ddI,
compound Q, clarithromycin, azithromycin, fluconazole, AZT,
aerosol pentamidine, ganciclovir (DHPG), diclazuril, DHEA,
peptide T, passive immunotherapy, hypericin, and many other
treatments.
Outside North America, add $20 per year for airmail postage,
$6 airmail for back issues #1 through #75, and $.50 for each
additional issue. Outside U. S. A., send U. S. funds by
international postal money order, or by travelers checks, or by
drafts or checks on U. S. banks.
To protect your privacy, we mail first class without
mentioning AIDS on the envelope, and we keep our subscriber list
confidential.
Copyright 1991 by John S. James. Permission granted for
non-commercial reproduction, provided that our address and phone
number are included if more than short quotations are used.
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