ddodell@stjhmc.fidonet.org (David Dodell) (02/13/91)
AIDS TREATMENT NEWS Issue #120, February 1, 1991
copyright 1991 by John S. James;
permission granted for non-commercial use.
CONTENTS: [items are separated by "*****" for this display]
The Epidemic and the War
Immune Globulin Proves Valuable for Treating Children,
Possibly Adults
California: Health Insurance Now Available for Persons
with AIDS
AIDS TREATMENT NEWS 1991: Focus and Plans
News Notes:
AIDS Survival Doubled;
Hospital Deaths Higher for Uninsured
Announcements:
National ddC/ddI Trial;
BRM Conference March 22-24;
HIV Entry Ban Will Be Removed;
Orange County AIDS Conference, March 5
***** The Epidemic and the War
by Denny Smith
When San Francisco was struck by the Loma Prieta Earthquake
in October 1989, the American public, the governments of
California and the United States, and the international media
devoted weeks of attention to the rescue stories and recovery
efforts. Congress arranged for speedy economic help to the Bay
Area, and insurance companies took out full page ads for many
days running to facilitate any claims their customers needed to
file. The Vice-President came to survey the tragedy, to express
his deep concern and that of the President as well.
For those San Franciscans who had already endured eight
years of lives lost to the AIDS epidemic, the intensity of the
response to the earthquake evoked mixed emotions. No Vice-
President ever visited the injured in San Francisco General's
AIDS ward. Instead, the White House seldom mentioned AIDS in the
ten years of the epidemic.
No insurance company ever placed eloquent ads in city
dailies offering to assist with the payment for HIV treatments.
In contrast, many insurers have gone to some trouble to back out
of coverage for legitimate treatments. In the first issue
published after the earthquake, AIDS TREATMENT NEWS commented
that "in two days, national institutions mobilized as they have
never done in eight years of AIDS," and that outside of
communities immediately affected by the epidemic, there had not
been "even a pale shadow of the mobilization that the far less
deadly earthquake has called forth."
Now, much of the world is traumatized by a new disaster:
the war in the Middle East, which is commanding the attention and
the assets of many nations, their citizens and their news media.
Every day, headlines convey the war's urgency, economic futures
are reassessed, and the greatest political gravity is assigned to
the crisis.
And once more, people who have been struggling with chronic
disasters in their lives and their communities are faced with
discrepancies in their government's priorities. One week after
the resort to warfare, the death toll from AIDS in the U. S.
passed 100,000. AIDS has killed more San Franciscans in a decade
than have died in the past century of wars and earthquakes
combined. The day after bombings against Iraq began, San
Francisco Mayor Art Agnos wrote in the San Francisco Examiner,
"The war we wanted was a war against AIDS, homelessness and
poverty." In the United States today, AIDS is the second leading
cause of death of men ages 25 to 44. Who will decide that the
vast human resources now poured into technology for ending life
can be used instead to build technology for preserving life?
Besides diverting attention from the AIDS crisis, the war
has impeded research and care due to staff shortages, as medical
professionals are sent to the Gulf. Long-term financial impacts
on medical research are not yet known, but almost certainly they
will be severe. Clearly the war will do no good for AIDS or any
other medical research and care; the question is what damage will
be done and how much. We plan to report as necessary on these
consequences of the Gulf War, but not to let it divert our
attention from the war against AIDS.
*****
Immune Globulin Proves Valuable For Treating Children, Possibly
Adults
by Denny Smith
Immune globulin is a concentrated and purified solution rich
in antibodies from pooled human blood. It has been tested for
some time in children with HIV, and some adults, as a method of
bolstering their immunity to various bacterial infections. The
antibody protection obtained from immune globulin is considered a
short-term, passive immunity. The drug is a licensed treatment,
often used as a way of conferring some measure of immunity
against hepatitis and measles immediately following a perceived
exposure to those viruses; it has also been used for reversing
low platelet counts related to immunodeficiency.
On January 17 the National Institute of Child Health and
Human Development announced results of a study of intravenous
immune globulin (IVIG) involving 372 children (from two months to
12 years of age) which found significant benefits in the group
receiving monthly IVIG, compared to those given a placebo. The
data was gathered at 28 trial sites beginning March 1, 1988, and
the recommendation to end the study was made January 10 of this
year, after a Data Safety Monitoring Board discerned the study's
trend.
IVIG was shown to decrease the number of bacterial
infections and hospitalizations, and to increase the time between
infections. These benefits were more dramatic in the children
with higher T-helper cell counts. Although the children with
less than 200 helper cells gained some protection compared to
their counterparts in the placebo group, the improvement was not
considered significant.
Other than mild brief rashes, few side effects were observed
from the IVIG. The particular product used in the study was
supplied by the Berkeley firm of Cutter Biological, which agreed
to continue supplying free IVIG to any study participant.
Many children in both the placebo and treatment arms were at
some point of the study also treated with AZT or aerosol
pentamidine; neither of these appeared to influence the effect of
IVIG. Physicians can obtain more details of the study, known as
protocol ACTG 045, by calling 800/TRIALS-A. The press release
announcing the study's results also noted that by the end of
November of last year, the Centers for Disease Control had
recorded 2,734 cases of AIDS in children under age 13, and that
two to ten times that many more children in the U. S. may be
HIV-infected; of these a disproportionate number are children of
color.
For a thorough discussion of IVIG in clinical pediatric AIDS
care, we refer readers to an article by E. Richard Stiehm, M. D.,
of the Division of Immunology at the University of California in
Los Angeles, published in the December 1989 issue of AIDS Medical
Report. In addition to controlling chronic bouts with bacterial
infections, Dr. Stiehm suggests that IVIG might effectively be
included in the treatment regimens for some serious opportunistic
infections in children, such as CMV pneumonia and respiratory
syncytial virus. Oral formulations of immune globulin have been
used against cryptosporidial diarrhea.
Adults May Also Benefit
IVIG is receiving more notice recently for treating adults
with AIDS, and not just to treat ITP, or low platelets. Paula
Sparti, M. D., an experienced HIV clinician in Miami, told us
that some of her adult patients who are troubled with chronic
infections like sinusitis and bronchitis have improved noticeably
after several months of IVIG infusions (see interview with Dr.
Sparti in the last issue of AIDS TREATMENT NEWS, #119). These
patients have low T-helper counts, in contrast to the lesser
response associated with low T-helper counts in the children's
study.
There are a number of reasons why results with adults and
children may not be comparable. For example, the value of immune
globulin for children comes from the contribution of antibodies
to help children's inexperienced immune systems resist unfamiliar
infections. In healthy adults, the immune system has already
collected a larger "repertoire" of protective antibodies through
years of exposure to the environment's microbes. But various
kinds of immunodeficiency in adults, including AIDS, can deplete
their acquired immunity, increasing susceptibility to common
infectious agents.
Alan Levin, M. D., an immunologist working with adult HIV
patients in San Francisco, presented related information at a
recent community forum. Dr. Levin explained that a substantial
value of immune globulin in treating HIV symptoms, aside from the
simple transfer of antibodies, is a regulatory effect on
inflammatory processes which characterize HIV infection, and on
the immune dysfunction set in motion with the inflammation. He
cautioned that IVIG can cause headaches, and rarely anaphylactic
reactions, and is very expensive. However, the cost in many
instances has been reimbursed by health insurance, especially if
the therapy is prescribed for treatment of repeated infections.
*****
California: Health Insurance Now Available for Persons with AIDS
by John S. James
California residents can now buy health insurance regardless
of health status -- meaning that no one is too sick to qualify --
under a new state program beginning February 1. This program,
the State of California Major Risk Medical Insurance Program,
subsidizes insurance companies to provide health coverage to
persons otherwise uninsurable due to chronic illness.
Major Risk policies are comparable to standard commercial
health insurance; they do cover prescription drugs, including
off-label use of approved drugs, as well as experimental drugs
provided under an FDA-approved "treatment IND. " The cost to the
individual is set by law to be about 25 percent more than what a
healthy person of the same age would pay for the same coverage --
meaning that the policy can be highly beneficial for persons with
costly medical problems.
This program is funded by money from the tobacco tax
approved by a voter initiative. Medical high-risk programs are
also being developed in some other states.
The Major Risk program in California has some important
limitations:
* Currently there is only enough money for 10,000 people.
According to one estimate, 25 times that many Californians are
now uninsured due to health status. Therefore enrollment may
close in a few weeks or months; the best time to get coverage is
now.
* Like other health insurance, these policies are expensive,
especially for older persons, since rates are based on age.
(Besides age, rates are also based on location, on which plan is
chosen, and, for families, on number of dependents.)
* To be able to serve more people with limited funds, the
Major Risk policies have a payment cap of $50,000 per year, and
$500,000 for the life of the program. In most cases this cap
will not be a problem for persons with AIDS, since treatment
usually does not cost that much.
* As with many commercial policies, there is a deductible,
which is $500 per year. After the patient has paid that amount,
the insurance covers 80 percent. For an individual, the maximum
out of pocket for a year is $2000 for an individual ($3000 for a
family); after that, the insurance pays 100 percent, up to the
cap mentioned above. The plan covers physicians, hospitals,
prescription drugs, and a number of other services including
outpatient, emergency care, rehabilitation, and some psychiatric
care; it does not cover some services, such as glasses or dental.
* So far three companies have joined the Major Risk program.
All of them are "preferred provider" plans, meaning that patients
need to use physicians on the list of the company they select, or
pay a larger part of the cost out of pocket. Therefore, before
joining the Major Risk program, a person should contact local
offices of each of the three companies (see below) for a list of
physicians in their area. Such checking may be particularly
important for persons who live in rural areas, where fewer
physicians are located.
* There will be a short delay, probably one to two months,
between applying for the policy and receiving coverage, which
starts on the first of the month after the application is
processed. Therefore persons should not wait until they are
hospitalized or otherwise need major care, but should obtain the
insurance in advance.
* Another reason for not waiting is that starting July 1,
there will be an additional 90-day waiting period for coverage of
pre-existing conditions. At this time, however, no such waiting
period applies.
* Under current regulations, persons who enroll and then
drop out of the plan, such as for nonpayment of premiums, will
need to wait a year to get back in. The intent of this
requirement is to make the program operate as insurance, with
people paying into it when they are healthy, instead of being a
subsidy for which people enroll only when they have major medical
costs.
* The Major Risk program is only available for persons who
live in California. If one moves out of the state, the insurance
ceases. Besides non-residents, two other groups are not eligible
for Major Risk: those who are eligible for COBRA coverage, and
those who are eligible for Medicare both part A and part B.
* This program will continue from year to year without
additional legislation. The California legislature may expand
the program in the future; it could, of course, possibly decide
to discontinue it.
For More Information
Applications for Major Risk Medical Insurance will be
accepted starting February 1; coverage should begin on some
policies as of March 1. Interested persons can send an
application request to MRMIP, 744 P St., Room 1077, Sacramento,
CA 95814, or phone 916/324-4695.
The three companies which have now signed up are Blue Cross,
Blue Shield, and Pacific Mutual. Persons will need to select one
of these when they apply for the program. Theoretically, the
coverage is the same from any of the companies, because a state-
appointed board decided what expenses would and would not be
covered; however, different physicians have enrolled with the
different companies as preferred providers. To find out which
local physicians are on the preferred provider list for each
company, contact each company and ask for a PPO directory for the
Major Risk Medical Insurance Program. Phone numbers for the
three companies now participating in the program are: Blue
Cross, 800/333-0912; Blue Shield, 800/351-2465; and Pacific
Mutual, 800/854-3027.
Some persons may also want to check with the state
government to see how well the companies have performed in the
past. Under the newly elected Commissioner of Insurance, John
Garamendi, the California Department of Insurance will now
release the number of complaints received about each company.
Another way to check is to ask one's physician's office which
companies are best at paying on time, etc.
A one-day seminar on California's Major Risk program, for
patients, physicians, and medical organizations, will be held
Friday, February 22, in Oakland. For more information, call
Strategic Health Systems, 714/777-8824.
History and Acknowledgement
Legislation authorizing the Major Risk program was passed
over a year ago (Title 10, California Code of Regulations,
Chapter 5.5), but at first little happened. Later, when
thousands of people had their health insurance suddenly cancelled
as companies withdrew coverage, legislators received many
complaints from constituents, and the legislation was
implemented. A board was appointed to set up the program; it had
the authority to sell insurance directly, but chose instead to
work with insurance companies who chose to participate, in order
to provide coverage more quickly.
A few private citizens worked closely with the board while
it was designing the program; their influence led to important
improvements, such as coverage for off-label and treatment-IND
drugs. One of these citizen-experts, Stan Long of Los Angeles,
provided us with much of the background on the program.
The Lobby for Individual Freedom and Equality (LIFE), a gay
and AIDS lobby in Sacramento, also helped in drafting the
regulations.
*****
AIDS TREATMENT NEWS 1991: Focus and Plans
by John S. James
The new year provided an occasion to examine our mission and
direction, and ask how we would like to change. What issues
affect our decisions on what to cover, or not cover, in AIDS
TREATMENT NEWS? In this article we step back for a more
philosophical overview of how we try to operate.
There have long been public concerns about the lack of AIDS
information, and also about being overwhelmed by the glut of it.
How can there be both too little information and too much at the
same time? We suspect that this paradox is possible because most
published information is not useful. Again and again we hear
complaints that press stories of the latest treatment advances
have no followup, and no way for readers to do anything with the
information. These stories have little value except to say that
something happened.
We suspect that this problem arises because the press no
longer provides the information needed for people to fulfill
their ostensible roles as sovereign citizens. The press gets
many stories essentially free by opening itself to manipulation
by those with something to put over. Some publications do resist
this system; the Wall Street Journal, for example, must provide
useful reports, because its readers are deemed important, and
they use the information in making financial decisions. And many
individuals throughout the media bring as much integrity to their
jobs as they can get away with. But we think that this analysis
-- that a hidden role of the media is to strip the public of its
sovereignty, to package the audience for sale to powerful
interests -- best explains the irrelevance of most news reports
to readers' lives. This problem is hardly unique to AIDS, but it
is less noticed in most other areas, where people seldom use
public information in making real decisions. The life and death
urgency of AIDS treatment decisions exposes the inadequacy of
most of what comes through the usual media channels.
The corrective, then, is to respect the reader as a person
making his or her own assessments and decisions. The goal should
be to provide quality intelligence which might be useful to that
person -- not to predetermine what the decisions should be and
then try to bring that outcome about. These goals may seem
obvious -- yet most people in the health-information business (or
in any business, for that matter) are not allowed to operate this
way. A drug company, for example, has an institutional
commitment to its own products; its employees are not likely to
put forth an analysis which favors the competition.
We believe that our effort to avoid such institutional bias
helps to explain the success of AIDS TREATMENT NEWS. Avoiding
this bias does not, of course, mean not having a point of view.
On the contrary, a point of view is usually essential for making
complex information intelligible. How, then, do we distinguish
what beliefs are or are not legitimate for guiding our coverage
in this newsletter? One distinction is between having a belief
but remaining willing to change when new evidence becomes
available vs. not being willing to change because of what one has
published in the past. Another standard we use is to try to
assure that our writing would be useful even to readers with a
different or opposite point of view.
Two less obvious, more philosophical dynamics help our
efforts to keep the material in AIDS TREATMENT NEWS relevant and
useful:
* In business management, there is a saying that results are
obtained by applying resources to opportunities, not to problems.
We can benefit from this principle because we can select, from
the entire range of AIDS treatments, what we want to work on. If
a drug is found to be less than promising, or if our research
bogs down for any reason, we can move quickly to something else.
If, for example, researchers are secretive, we can choose another
treatment to write about. (Secrecy and intrigue are often used
to enhance the value of something which would not succeed on its
own. Most new drugs do begin their life in secret; but at that
stage they are not available as treatment options, and therefore
not of immediate interest to our readers.)
Almost nobody else involved in AIDS treatments has the
journalist's freedom to move at will to where opportunities are
best. Scientists at pharmaceutical companies, for example, are
constrained to work on their companies' products -- even if it
becomes apparent that other treatments are better. University
scientists, theoretically free to study anything, may need years
to change research direction, because of the need to find new
sources of funding, or to obtain specialized facilities or
training.
* How do we select which treatments to cover from among
hundreds of possibilities? Of course there is no formula. But
one mental tool has proved helpful for this kind of unstructured
decision. Like the gardener who provides a fertile bed, plants
many seeds, and then selects the plants which grow best, one can
provide a fertile ground for many different hypotheses, ideas, or
treatment options, and see which ones continue to do well over
time. Whenever we learn about a new viewpoint, a new way of
judging, evaluating, or prioritizing the available theories or
treatment options, we apply it to the various potential
treatments as a test. Those treatments which continue to look
strong under all or almost all points of view remain leading
candidates; those which fail any of the evaluation viewpoints are
weakened. The strongest candidates for the purpose at hand (for
us, to write articles about) emerge from this process
organically.
This approach gives answers in weights or probabilities, not
as a definite yes or no. It moves directly to the practicality of
each treatment in a single integral process, without making a
special stop at the question of efficacy. This is different from
the philosophy now prevailing in drug development and regulation,
which makes proof of efficacy the most critical part of the
process. Obviously efficacy is essential; but in practice, we
often have no exact knowledge of it, and cannot put all decisions
on hold until we do.
Other criteria we use in deciding what treatments to
investigate and write about are more immediate and
straightforward:
* We have long believed that one of the best AIDS survival
strategies at this time is to try a number of safe and well-
supported treatment possibilities, keeping the ones which seem to
help and discarding the others, to find treatment combinations
which work best for oneself. This process is an individual one;
the same treatments may not work for someone else. At AIDS
TREATMENT NEWS our most important function is to provide
accessible treatment information, to help increase and improve
the options available.
* We also cover public policy issues which affect treatment
research and development, to help the AIDS community work
together toward better drugs in the future. This work is
essential, because individual decisions alone are not yet enough
for most peoples' survival. We need better treatments, and
therefore we need high quality, well planned, practical research;
community involvement is critically important for assuring it.
* We seldom rush to be the first with the news. Instead, we
talk with people who are well informed about treatments, and we
prefer to report a new development after it has already acquired
some knowledgeable following, rather than before. It is hard to
judge a treatment early in its history, when little data is
available; also, most potential drugs in early development will
ultimately fail. So instead of competing for scoops, we let the
community of experts judge first; then we contribute by bringing
together the most important information and making it easy to
understand.
In evaluating expert or other opinions, we consider the
credibility and also the motives of the source. More trustworthy
information comes from reputable physicians and scientists who
are putting their reputations on the line, or from people in the
AIDS community who have no financial or other personal conflict
of interest and are motivated only to find good treatments. Less
trustworthy information comes from promoters with products to
sell.
* Occasionally we learn about a treatment which clearly
needs more attention than it is getting, and then we may publish
one or more major articles, without waiting for expert consensus.
Sometimes we have been right, sometimes not; often no one yet
knows. Examples include our reports on AL 721 (April 1986),
aerosol pentamidine (January 1987), dextran sulfate (May 1987),
fluconazole (September 1987), DHEA (January 1988), hypericin
(August 1988), ddI (January 1989), roxithromycin and azithromycin
(March 1989), NAC (October 1989), aspirin (August 1990), and
clarithromycin (October 1990). We consider these articles among
the most important work we have done.
* We are less impressed than some others by theories, unless
they have at least some preliminary practical results which
support them. Even leading scientists sometimes make the mistake
of going directly from a theory to a complex, costly, and time-
consuming trial or other project, without finding ways to do
quick checks first to see if their theory seems to be working in
practice. As a result, their projects may never get off the
ground, or may tie up substantial resources for no good purpose.
Today's understanding of AIDS is far more primitive than the
public realizes, than the experts' clean charts and pictures
suggest. For now, therefore, theories serve mainly as guides or
suggestions for what might be tried; they are not descriptions of
what is actually happening with the disease.
* When AIDS TREATMENT NEWS began, we planned to cover
"experimental and alternative" treatments. (Later we changed the
wording of our statement of purpose to "experimental and
complementary," to emphasize that non-standard treatments should
not replace good conventional medical care, but rather add to
it.) Our original plan was not to cover conventional treatments,
since physicians and patients would have better sources for this
information. But recently some of our most valuable articles, as
judged by what our readers tell us, were closer to conventional
medicine -- for example, the overview of pneumocystis prophylaxis
(November 1990). Interviews with leading HIV physicians have
also been important; we hope to have more of them in the future.
* Some readers feel that we have become too conservative;
they want more coverage of "alternative," non-mainstream
treatments. We agree that more coverage is needed, but we have
mixed feelings on this issue. When we began over four years ago,
useful mainstream research was almost nonexistent; the leading
edge of AIDS treatment was in the underground. But today the
leading edge is often in major pharmaceutical companies or
medical centers. We must cover the most important news from
wherever it occurs.
Most of the treatments which are outside of the medical
mainstream but still in widespread use (for example, garlic,
exercise, or acupuncture) have not been rejected on the basis of
evidence, but rather not studied because they lack commercial
potential. Some may well be of value; and it is important in any
case to provide unbiased information on treatments which people
are using. Perhaps we underemphasized complementary treatments
in 1990. But it is hard to evaluate treatments when little has
been published in mainstream medical and scientific literature.
* One dilemma is that the advances which ultimately may be
most important, such as the rational design of new chemical
entities, may have no near-term relevance to our readers, as the
substances are not available, or not suitable for use because of
unknown risks. Still we need to cover this news so that our
readers will be oriented to what is happening. Perhaps the most
important issue now facing the community is how to reform the
regulatory process so that important potential advances (for
example, the new Merck or Boehringer Ingelheim non-nucleoside
drugs, or the protease inhibitors now being developed by many
pharmaceutical companies) will have a rational development path,
without the senseless delays which have so far been imposed.
People need to realize that there are potentially major advances
now entering human trials, in order to understand how critical
this issue is.
Geographical Issues
When we write about treatments, it does not matter where the
news comes from, as long as we can substantiate it. But when we
cover treatment activism, are we a national publication, or are
we partial to San Francisco and the West Coast, where we are
located?
We want to provide national coverage, and therefore we make
efforts to avoid a San Francisco bias. But we also believe it
would be a mistake to aim to be entirely geography-free.
Obviously we can attend more meetings locally than in other areas
such as New York or Washington; we can know the local people,
projects, and issues better. Part of our mission is to report to
a national audience from San Francisco. If, for example, we were
located in Washington, DC, we would publish the same news about
new treatments, but otherwise we would focus on Federal
activities affecting treatment development -- which we cannot
cover in depth from San Francisco.
Covering the News
Should AIDS TREATMENT NEWS focus more effort on in-depth
reports on stories which appear in the general news media,
providing the background which the news stories do not? At this
time we have decided not to. The main reason is that we have
found that most treatment news reported in the general media is
not valuable. To say so in print would require research time to
verify each case, directing our time, attention, and space in the
newsletter to what is not important. Another reason is that, as
explained above, we prefer to wait and hear what the community of
experts has to say before deciding which treatments to cover.
The media, however, is most interested in a story when it is new,
and at that time the expert evaluation we seek may not be
available.
Medical and AIDS Publications
Should we specialize in abstracting AIDS news from medical
journals? Again we have decided not to. One reason is that at
least two newsletters already perform this function: ATIN: AIDS
Targeted Information Newsletter (for subscription information,
call 800/638-6324, or 800/638-4007 in Maryland); and Acquired
Immune Deficiency Syndrome Newsletter, 1680 N. Vine St., Suite
1006, Los Angeles, CA 90028.
Let Us Know
Much of our information comes from readers; we pay careful
attention to all correspondence and comments we receive. Please
let us know if you have any ideas about how we could make AIDS
TREATMENT NEWS more useful to you or to others.
*****
News Notes
** British Study: People with AIDS Living Twice As Long
A study of medical records, published January 25 in the
British Medical Journal, found that AIDS survival doubled between
1984 and 1987, from a median of 10 months to 20 months, among
patients treated at St. Mary's Hospital in London. According to a
Reuters report on the study (we have not yet obtained the
original article), deaths from pneumocystis dropped from 46
percent in 1986 to 3 percent in 1989.
KS and lymphoma were increasing as causes of death,
apparently because people were living longer due to improved
prevention and treatment of other AIDS complications.
** Hospital Deaths Higher for Uninsured
A study of over half a million discharge records of patients
hospitalized in the United States in 1987 found that the in-
hospital death rate was 1.2 to 3.2 times higher among uninsured
patients, in 11 of 16 groups which were analyzed. The study also
found that although uninsured patients were in worse condition
than privately insured patients when they entered the hospital,
they were discharged sooner.
The study was published January 16 in the Journal of the
American Medical Association.
*****
Announcements
** ddC/ddI Comparison Study Recruiting
A major trial to compare antivirals ddC and ddI is now
seeking 400 participants in cities throughout the United States.
Volunteers must either be at least age 13, be unable to tolerate
AZT or have failed treatment with that drug, and must have T-
helper counts of 300 or less, or have an AIDS diagnosis.
The trial will take place at sites in Atlanta, Chicago,
Denver, Detroit, New Haven, New Orleans, New York (sites in
Manhattan, Brooklyn, and Bronx), Newark, Portland, Richmond, San
Francisco, Tucson, Washington DC, and Wilmington. The research
is being conducted by the Community Based Programs for Clinical
Research on AIDS (CPCRA), a community-based trials network in the
U. S. National Institute of Allergy and Infectious Diseases.
Most of the trial sites should be open for enrollment now.
For more information, call the AIDS Clinical Trials Information
Service, 800/TRIALS-A.
** BRM (Biological Response Modifiers) Conference, March 22-24 in
Quebec City
The First International Congress on Biological Response
Modifiers will be held March 22-24, 1991 at the Hilton
International Qubec, Qubec City, Canada. The conference is
organized by the Inter-American Society for Chemotherapy.
The following description is from the conference brochure:
"The exciting and challenging field of BRM represents a
revolutionary approach to the treatment of several pathological
processes. BRM offers the potential for the development of
breakthrough therapies against cancer and a wide range of
infectious conditions, including AIDS.
"As the First International Conference on Biological
Response Modifiers, this meeting is of immediate importance to
physicians involved in both clinical practice and investigative
research, as well as research scientists from academia, the
pharmaceutical industry, and biotechnology organizations."
A list of scientific topics includes: BRM in AIDS, BRM in
cancer, BRM in bacterial, parasitic, fungal and viral diseases,
BRM as antiviral agents, BRM and the immune system, BRM and
hematopoiesis, BRM and anti-HIV drugs, colony stimulating
factors, other growth factors, interferons, interleukins, tumor
necrosis factor, leukotrienes, and platelet activating factor.
[Note: the term "biological response modifiers" is not new,
but the area is now receiving intense scientific interest. The
phrase has sometimes been used interchangeably with "immune
modulators," but "biological response modifiers" is more general,
in that the same mechanisms which control the immune system also
control growth and other functions of many cells.]
The conference will be held in English.
For more information, call Michel G. Bergeron, M. D.,
418/654-2705, or 418/654-2715 (fax).
** HIV Entry Ban Will Be Removed
On January 23 the U. S. Department of Health and Human
Services formally published a proposal to end the restrictions
against travelers and immigrants with HIV entering the United
States. Leprosy and several sexually transmitted diseases were
also removed from the list, leaving tuberculosis as the only
disease for which persons will be excluded. The new rule will
not take effect until June 1.
The HIV visitor ban caused major problems for the
International Conference on AIDS in San Francisco last June.
Over 100 organizations, including the International League of Red
Cross and Red Crescent Societies, the British Medical
Association, and the European Parliament, boycotted the
conference because the travel restrictions had no medical
rationale and made it difficult for delegates to attend. Later,
Harvard University said that it would withdraw its sponsorship of
the 1992 Conference unless the restrictions were changed.
The Department's intent to remove the ban was widely
reported in early January 1991.
** Orange County, California, AIDS Conference, March 5
A one-day conference, "HIV/AIDS on the Front Line; Resources
and Strategies for Physicians and Allied Health Professionals"
will be held March 5 in Garden Grove, California. It is
sponsored by the Orange County Medical Society, the University of
California Irvine Medical Center, and a number of other medical
and AIDS organizations.
Topics include treatment and prevention of opportunistic
infections, ethical issues, legal issues, occupational exposure,
and a panel discussion on the future of the epidemic.
For a copy of the conference brochure or for other
information, call Orange County AIDS Coordination, 714/834-8798.
*****
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
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
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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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