ddodell@stjhmc.fidonet.org (David Dodell) (08/07/90)
AIDS Treatment News #107, July 20, 1990
Conference Report, Part II
Experimental Antivirals
AZT, Antiviral Combinations, and Resistance
Cryptosporidiosis: Scattered Success, Research Delays
Announcements
Conference Report, Part II
Our previous issue included an overview of the most
important practical treatment information from the Sixth
International Conference on AIDS, from a public talk by Marcus
Conant, M. D. This issue continues our Conference coverage:
* New discoveries of potential drugs outside of the dominant
preconceptions may offer the most promising possibilities for
future development -- because with them, the easy research has
not already been done. But these new developments risk being
ignored. Newspapers seldom acknowledge their existence, and few
scientists, physicians, or reporters have time to read or listen
to all the Conference presentations. Our article on experimental
antivirals examines two scientific papers which deserve
attention.
* Many Conference presentations concerned AZT dosage,
combination therapy, and antiviral resistance. The article by
Michelle Roland on AZT outlines these developments.
* Opportunistic infections are potentially easier to treat
than HIV, and yet they have often been neglected in the research
conducted up to now. As a result, advances against opportunistic
infections have been among the most practical of new
developments, and at the same time among the most disappointing.
In this issue, Denny Smith reviews cryptosporidiosis reports
presented at the Conference.
Experimental Antivirals
by John S. James
Dozens of different potential antivirals were mentioned in
presentations at the Sixth International Conference on AIDS. But
usually the results were too sketchy to be useful, or otherwise
relevant to only a handful of specialists.
If we were asked to name one "sleeper" at the Conference --
one project which we believe may have great importance but which
received little attention -- it would be the work on melanins,
described below. It is too early to know if this treatment will
be useful -- but it would be easy to find out.
By contrast, the paper on Chinese medicines with anti-HIV
activity in laboratory tests (below) did attract attention --
partly because virologist David Ho, known for his work on plasma
viremia, assisted in the project. As with melanins, we
highlighted this work because it offers practical advantages. A
medicine already in routine human use can clearly be developed
faster as an AIDS/HIV treatment than a new chemical never used
before. But Chinese medicines may be unpatentable, and they fit
poorly into the Western medical-industrial complex, so the
research needed is hard to fund. Community-based organizations
should pay special attention to treatments which could be
developed rapidly, but may not be developed at all without
community pressure.
Readers should note that this article is based mainly on
information presented at the Conference, as we have not had time
to contact the researchers or do other followup.
For information on how to obtain the Conference abstracts
and tapes referred to in this issue, see "Obtaining Conference
Information," under Announcements.
Melanins
This work, by researchers at Vanderbilt University Medical
School, could easily be missed, because the interesting
information appeared for only one day on the poster presentation
itself (poster #Th.A. 228), not in the published abstract or in
an article published by the investigators. To anyone not at the
poster that day, melanins would look like just another of the
dozens of potential treatments which appear promising in
laboratory tests and ought to be investigated further for
possible human use for treating AIDS.
Melanins are pigments which are already found in the body in
hair, skin, and eyes. Although recognized for at least 60 years,
their chemical structure is not known, and no therapeutic use for
these chemicals has been found. The melanins which occur
naturally in the body are insoluble in water, but the synthetic
forms studied as an anti-HIV treatment are soluble. Melanins are
easy to make, can be given orally, and are inexpensive.
The published abstract (reference above) reported that small
concentrations of melanins (0.3 to 10 ug/ml) blocked infection of
human T-helper cells with HIV in laboratory tests; three
different cell lines and three different viruses (including HIV-
2) were used. A more detailed report of the same work was
published in April of this year. (Montefiori, D. C. and others.
Inhibition of human immunodeficiency virus type 1 replication and
cytopathicity by synthetic soluble catecholamine melanins in
vitro. Biochemical and Biophysical Research Communications,
volume 168, number 1, pages 200-205, April 16, 1990.) The
mechanism of action is not known, but melanins did not inhibit
reverse transcriptase, so clearly they work entirely differently
than AZT. (One test suggested that they probably did not get
inside the cells.)
Another report, apparently of research too recent for
inclusion in the published abstract or the journal article,
appeared only on the poster itself. Synthetic melanins were
given to mice in their drinking water, and their urine had anti-
HIV activity even when diluted up to 200 times; control urine of
mice given plain water had no effect. The mice showed no
toxicity from the chemical, and they ate and drank as much as the
control mice during the five-day test. (Much larger doses of
melanin given by injection did kill mice, however, and the
researchers estimated the lethal dose for the animals at between
one and ten grams per kilogram of body weight.)
Comment: Although this research is preliminary and much
uncertainty remains, we find it especially significant that urine
concentration 200 times that needed to show anti-HIV activity
could be achieved with no apparent harm to the animals (blood
concentrations were not reported). Other reasons why this work
deserves high-priority followup is that melanins are considered
relatively innocuous, can be given orally (at least in the animal
tests), are very easy to produce (the synthesis could be carried
out in a high school chemistry lab), and are inexpensive. Also,
since melanins work very differently than the available
antivirals like AZT, combinations might be especially effective.
Many questions can be raised. Melanins worked with
laboratory cell lines and viruses; would they work with fresh
cells and viruses from patients? What is the toxicity of these
chemicals in humans? And melanins may interact with certain
antibiotics or other drugs; how might this complicate their use?
Yet the existing information suggests a strong possibility
that melanins might have an important impact on AIDS/HIV
treatment worldwide. We are concerned that this opportunity may
not be realized, since under the commercial and regulatory
structure of drug development in the United States it will take
years before any standard drug could become available from this
early research -- due to delays with patents, business
negotiations, corporate restructuring, etc., as well as Federal
requirements such as excessive animal tests which should not be
allowed to impede progress in an emergency. Scattered reforms
have been made, but no one has studied the practical operation of
drug development from beginning to end, or has the authority
necessary to make the changes needed to meet the AIDS emergency
effectively.
We suggest that community-based and other research
organizations -- including institutions outside of the United
States -- investigate melanins further, and proceed if justified
to develop this information into a practical AIDS/HIV treatment.
Chinese Medicines
At the UCLA School of Medicine and Cedars-Sinai Medical
Center in Los Angeles, 57 injectable Chinese medicines were
screened against HIV in laboratory-cell cultures; 10 showed
activity (poster #Th.A. 237). These ten were then screened
against primary HIV-1 isolates (and also against HIV-2). Using
primary isolates is important because recently it has been found
that tests with cells and viruses which have lived for years in
laboratories -- the ones most convenient for scientists to use --
can show very different results than the same tests with cells
and viruses taken recently from patients.
In the first phase of testing (using cultured cells and
viruses), the therapeutic index (ratio between the concentration
which was effective and that which was harmful to the cells)
ranged from 22 to 333. Of the ten drugs which passed the first
test, the two with the greatest therapeutic index were Injection
Yin Huang (333), and Injection Co. Dan Shen (174). We do not
have the result of the second-phase tests.
Comment: Treatments based on Chinese medicine are usually
ignored in the U. S. drug-development system. The cultural bias
of Western science and medicine is to isolate one or more pure
chemicals which are effective, and then hopefully synthesize them
-- adding years of research time when an adequate herbal
treatment may already be available.
Community-based research organizations could make a major
and cost-effective contribution by organizing professional
investigation of and advocacy for treatments which, due to
cultural or commercial biases, are unlikely to get a prompt
hearing otherwise. Then small phase I/II trials could obtain
initial information about effectiveness in patients, using
standard measurements such as T-helper counts, and p24 antigen
and antibody levels. These trials could be conducted easily when
the treatments being tested are already in widespread human use.
AZT, Antiviral Combinations, and Resistance
by Michelle Roland
Most of the clinically useful information from the Sixth
International Conference on AIDS concerned either fine-tuning of
the use of drugs that are already approved and in standard use
(e.g., AZT, alpha-interferon, and various prophylaxes for
pneumocystis), or preliminary suggestions on how to use drugs
that are not yet FDA-approved but are likely to become more
broadly available in the coming months and years (e.g., the
anti-HIV drugs ddC and ddI, and the anti-CMV drug foscarnet).
Much of the remaining information was more useful to researchers,
doctors who are also involved in designing clinical trials, and
policy makers and activists who are trying to implement
increasingly efficient and attractive ways to test potential
treatments.
The major focus of this article will be on information which
people can use today in making treatment choices. We will also
discuss some of the important information on the use of
treatments and combinations of treatments which may be available
in the foreseeable future.
AZT: When and How Much?
Much discussion concerned data already thoroughly critiqued
in the past several months about when to start AZT and how much
to use. The latest official recommendations suggest 600 mg per
day for persons with fewer that 500 T-helper cells. Most
physicians now use either 500 or 600 mg.
What about AZT for people with more than 500 T-helper cells?
Margaret Fischl, M. D., a leading researcher on AZT, reported
that the large government-sponsored study with asymptomatic
patients has not at this time found a statistically significant
difference in disease progression between patients with more than
500 T-helper cells who took AZT and those who took a placebo.
However she also noted that this data is inconclusive, and does
not show whether or not AZT would be helpful for these people.
At this time very few early studies are designed to test the
effects of drugs in asymptomatic patients. Pharmaceutical
companies may avoid studies in groups of people where the effect
may not be big enough to earn FDA approval of their drug. But
answers for these patients will become increasingly important to
those who are wondering when they should start using an anti-
retroviral, or prophylaxis for specific opportunistic infections.
One very small study suggested that 300 mg of AZT per day
may be effective. This study was designed to test the effect of
combining high dose acyclovir with AZT. Only 22 patients were
enrolled; approximately half took 600 mg of AZT and the others
took 300 mg. Although the addition of acyclovir in half of the
patients on each dose did not produce differences in tests used
to assess viral activity (p24 antigen and plasma viremia), the
300 mg dose appeared as effective in lowering these measures, and
perhaps even more effective in sustaining an increase in T-
helper cell counts, as the 600 mg dose.
This small study is far from conclusive, but it does suggest
that people who have to lower their AZT dosage because of side
effects or the use of other drugs which depress blood cell counts
may still benefit. It also supports the growing suspicion that
we have not yet found the minimum effective dose of AZT.
This confusion about dosage has implications for how early
tests of anti-viral drugs in humans are designed and interpreted.
Currently, the standard approach is to look for what is called
the "maximum tolerated dose." As we have seen with the example
of AZT, this dose was quite toxic. Yet early studies continue to
look for the maximum dose, and then later studies use that dose,
because it is the best studied. Treatment activists have long
pointed out this flaw in drug development, and have suggested
using the infectious-disease approach of seeking the minimum
effective dose, instead of the cancer-chemotherapy approach of
maximum dose. But pharmaceutical companies have an incentive to
use larger doses, because if their drug fails to show efficacy in
a controlled trial, they may not get another chance to test it,
and their drug will be dead; yet they can reduce the dose later
if necessary to manage toxicity.
AZT in Combination with Approved Drugs
* Acyclovir: It has long been believed that high doses of
acyclovir may increase the effectiveness of AZT. One small study
reported on AZT plus high dose acyclovir; it did not show any
increased anti-viral benefit from the addition of acyclovir. It
is important to remember that acyclovir is still useful in
treating herpes infections and often in preventing their
recurrence.
* Alpha Interferon: Alpha interferon is currently approved
for the treatment of Kaposi's sarcoma in some people with AIDS.
Some scientists and doctors believe that it might increase the
effectiveness of AZT. Preliminary data from an ongoing study on
the use of alpha interferon with AZT (600 mg) in patients with
more than 500 T-helper cells does not yet answer this question.
Unfortunately, more subjective and laboratory toxicities have
occurred in the combination group than in patients on either drug
alone. These side effects included fatigue, loss of appetite,
nausea, elevated liver enzymes, and decreased red and white blood
cell counts. However, so far the numbers of people who have
withdrawn from the three parts of the study are the same
(suggesting that there was no great difference in side effects
severe enough to require stopping treatment), and dose
modifications were required in all three parts to reach safe and
comfortable doses. Therefore, if this combination is found to be
effective, it may be possible to tailor doses to individual
patients to manage side effects.
After one year there were no significant differences in
changes in T-helper cell counts between the group taking 600 mg
AZT with alpha interferon, and the group taking 1200 mg of AZT
alone. About 10 percent of the patients were p24 antigen
positive when they entered the study and all experienced a
decrease in this lab value, which may be a marker of disease
progression. Although the numbers are very small (a total of
only 10 patients), there appeared to be a more sustained decrease
in p24 antigen levels in the combination group than in the AZT-
only group. It has been difficult to complete enrollment in the
study; therefore the data is incomplete and not entirely useful.
[Note: readers should be careful in interpreting statements
that "no statistically significant difference" has been found in
an incomplete study; this does not mean no difference has been
found. There may be a big difference -- but just not enough
patients yet to provide statistical proof. Also, the criteria
for claiming statistical significance for an incomplete study --
and terminating the study as a result -- are extremely
conservative, often several times as severe as the criteria for
claiming statistical significance at the end of the study; for
background on this statistical quirk, see AIDS TREATMENT NEWS
#81, June 16, 1989. In addition, researchers may be reluctant to
give out any early information about a trial which is continuing
(unless those results are so extreme that they force the trial to
be stopped), because early information could cause patients to
drop out of the arms which seem less effective, which could bias
or otherwise damage the study.]
AZT in Combination with Experimental Drugs
The only information on the combination of AZT with an
experimental drug that was presented at the Conference was on
ddC, which works in the same way as AZT as an inhibitor of the
enzyme reverse transcriptase, but is different enough that it has
different side effects. The idea of combining antiretroviral
treatments has three main attractions. First, combining or
alternating treatments may make it possible to manage the toxic
side effects of each treatment better than with a single
treatment. Second, the problem of drug-resistant strains of HIV
may be reduced by using more than one drug with a similar
mechanism, like the nucleoside analogs AZT, ddC and ddI (more on
resistance below). Third, by combining drugs that block
different parts of the viral life cycle, it should be possible to
limit HIV replication more completely than we have been able to
accomplish with a single anti-viral drug alone.
The consensus at the Conference was that drug combination
(either using the drugs at the same time, or in alternation) is
the wave of the future. As more antivirals become available to
patients through expanded access programs and eventually through
FDA approval, the questions which need to be answered today are
how to use these drugs together safely and effectively.
The ddC plus AZT studies presented at the Conference show
us more about how complex the problem of interpreting and
comparing studies has become than about how best to use these
drugs together. None of the three studies used the same dose
combinations, thus the different ways of combining these drugs
cannot be compared across the studies. Two of the studies tested
alternating the two drugs every week or month, or using each one
intermittently (with a period of no treatment), one in patients
who were intolerant to AZT and one in patients who were not
intolerant to AZT when they entered the study. The third tested
combinations of the drug used concurrently. Each study compared
various dose combinations.
The worst side effect of ddC is peripheral neuropathy, while
the primary side effects of AZT are on the bone marrow, leading
to depressed blood cell counts. So the challenge of studying
combinations or alternations of these drugs is to minimize
peripheral neuropathy and red and white blood cell count
depression while maximizing increases in T-helper cell counts and
other markers of anti-viral activity.
Unfortunately, the major study showed that the most
effective dose of ddC (high) was also the most toxic. This
toxicity seems to be decreased by alternating AZT and ddC on a
monthly rather than weekly schedule. Thus, the conclusion of the
researchers who presented this data is that the optimum dosing
schedule is monthly alternating high dose ddC with AZT. Although
that is one conclusion which could be reached, some people may
prefer to continue to look for more desirable combinations of
these two drugs. It is important to note that this study used
1200 mg of AZT.
In patients who were intolerant of AZT, there was more
depression of blood cell counts in the monthly than weekly
alternating dose group; the least blood-count toxicity was in the
group that used ddC on an intermittent basis without AZT at all.
The researchers who conducted this study concluded that monthly
alternating low dose ddC with AZT may be an acceptable "salvage
therapy" for patients who have failed AZT. Again, some people
would probably rather try other combinations, including longer
periods on ddC than AZT, and lower doses of AZT, before reaching
a conclusion about optimum dosing of these drugs in people who
are intolerant of AZT.
Finally, the study which tested the use of AZT and ddC at
the same time found no statistically significant differences in
either safety or effectiveness between the various combinations
tested -- at least in the partial data available at this time.
It used lower dosages of both AZT and ddC than did the two
studies discussed above. Because this study is not completed,
the data did not yet provide much useful information. It will be
impossible to compare this study directly with the other two
because of differences in the dosages used.
How can drug combinations be tested better in the future?
One approach, called response-surface methodology, was developed
in chemical engineering, where it is often necessary to vary the
concentrations of two or more chemicals to find the specific
combination which works best. In this kind of trial, a matrix of
many different dosage combinations of two drugs is tested
simultaneously, but very few patients are needed for each "cell"
-- each specific dose combination -- perhaps only three or four
patients, far too few for an arm of a standard drug trial. The
reason so few are needed is that the overall pattern which
emerges shows the best combination, although each individual cell
may be too small to provide statistical information by itself. As
far as we know, response-surface methodology has not yet been
used in AIDS research, although it is being discussed. It offers
the advantage of testing all reasonable dosage combinations at
the same time and for about the same expense and number of
patients as a standard trial which only compares a few dosage
combinations.
HIV Resistance to Anti-Viral Treatments
Antiviral drug resistance was a significant topic at the
Conference. Because one of the key enzymes involved in the
replication of HIV, reverse transcriptase, is quite error prone,
HIV mutates frequently. Some of the strains that are formed as a
result of the mutations are resistant to antiviral drugs like
AZT. AZT-resistant strains of the virus can be found in patients
who have never taken AZT, but are most frequently isolated from
patients who have been taking AZT for more than 6 months. AZT
resistance appears to increase with the amount of time one has
taken the drug, although some scientists believe that resistance
may develop more slowly when antiretrovirals are started earlier
in HIV infection. Fortunately, cross resistance does not seem to
be a problem with the nucleoside analogs that are being tested
today (AZT, ddC, ddI). Therefore, even if AZT has stopped
working because viral resistance has developed, ddI or ddC should
still work.
The clinical importance of AZT resistance has not been
proven. But some scientists believe that all future clinical
trials of antiretroviral drugs should include laboratory tests of
resistance. Managing the ability of HIV to mutate into resistant
forms is one of the reasons that many researchers believe that
combination anti-retroviral therapies will be so important.
Other viruses that affect people with HIV infection also
form drug resistant strains. For example, herpes viruses can
become resistant to acyclovir; the good news is that they often
still respond to the experimental anti-viral drug, foscarnet.
Also, CMV (cytomegalovirus), which often affects the retina of
the eye but can also cause problems in the colon, spleen and
other organs, has been shown to develop resistance to
ganciclovir, the only approved therapy for its treatment. The
resistance issue is one of the crucial reasons that test tube and
human trials of new antivirals for virally induced opportunistic
infections are in great need of research attention and money.
For More Information
More information is available in the following Conference
audio tapes. See "Obtaining Conference Information" in
Announcements, below, for ordering information. Note that each
of these sessions is recorded on two cassettes.
Talk by Margaret Fischl, Thursday plenary session. Tapes
#90ICA-10 and 90ICA-11.
New Concepts Regarding the Use of Zidovudine (AZT). Tapes
#90ICA-46 and 90ICA-47.
Clinical Trials with New Antiretrovirals. Tapes #90ICA-50 and
90ICA-51.
CMV and Other Viral Opportunistic Infections. Tapes #90ICA-60
and 90ICA-61.
Resistance to Antiretrovirals. Tapes #90ICA-66 and 90ICA-67.
In addition, information from the following abstracts was used in
this article:
On viral resistance: S. B. 81 through S. B. 88.
Foscarnet for acyclovir-resistant herpes: Th.B. 446 and Th.B.
447
Ganciclovir resistance in CMV retinitis: F. B. 93.
AZT plus alpha interferon: Th.B. 22.
ddC studies: Th.B. 23, S. B. 425, S. B. 426.
AZT plus acyclovir: Th.B. 24.
Cryptosporidiosis: Scattered Success, Research Delays
by Denny Smith
Several antibiotics and antidiarrheals were among the
treatments discussed at the International AIDS Conference last
month for use against AIDS-related infections of Cryptosporidium
parvum. Rosemary Soave, M. D., has been investigating new
therapies for cryptosporidiosis at Cornell University. She
presented results of her studies of diclazuril and spiramycin, as
well as data on other agents under investigation.
The results regarding diclazuril were approximately the same
as those reported in our last update on treatment for
cryptosporidiosis (see AIDS TREATMENT NEWS #95, Jan. 19, 1990).
Various responses of symptom improvement and decreases in counts
of the parasite's oocysts were seen using doses ranging from 200
mg to 600 mg a day, with stronger responses at the higher doses.
Dr. Soave noted that serum (blood) levels of diclazuril were
measurably higher in participants who had the strongest response.
The drug used in these studies was hastily prepared for human
consumption after a veterinary version for treating parasites in
poultry, under the trade name Clinicox, was also discovered
recently to be useful in some people. Ironically, the original
compound formulated for chickens was apparently better absorbed
than the newer "human" version. We have not heard of any ill
effects in people who tried the veterinary product.
Dr. Soave is eager to continue studies of diclazuril, but
the manufacturer claims there are limited supplies of the drug
for humans. We spoke to Mr. Bob Lagendre, spokesperson for
Janssen Pharmaceutica in the U. S., who said that they are now
revising the formulation to improve absorption and that within a
few months the manufacturing headquarters in Belgium hopes to
make available two new analogs, dubbed "clazuril" and
"letrazuril." These will be studied in six new trials around the
U. S.
In the past, oral spiramycin did not appear to affect
cryptosporidiosis significantly. But administered intravenously,
spiramycin is now obtaining some good results. Of fifteen
patients who completed a regimen of IV spiramycin, four
experienced a complete response in symptom improvements and a
decrease in cyst counts. Two of the four exhibited a complete
absence of parasites in stool specimens after the treatment.
Other therapies presented at the Conference included
hyperimmune bovine colostrum, transfer factor, paromomycin,
loperamide oxide, and two analogs of the drug somatostatin, SMS
201-995 and Vapreotide.
Hyperimmune colostrum has been discussed now for several
years as a potential therapy for cryptosporidiosis. The
particular study presented at the Conference was authored by
several Danish institutions and offered mildly positive results.
Another study of colostrum was recently reported in AIDS (volume
4, number 6) by researchers at St. Vincent's Hospital in New
York. A very small study of five patients produced results which
warrant larger, more carefully-designed trials of colostrum.
The transfer factor discussed by Dr. Soave was an extract of
lymphocytes derived from infected cows. Fourteen people who
received this transfer factor demonstrated both improved symptoms
and decreased cyst counts. Neither hyperimmune colostrum nor
transfer factor are widely accessible now to people diagnosed
with cryptosporidiosis.
Paromomycin, a prescription drug available under the brand
name Humatin, is used for treating intestinal parasites. Park
Plaza Hospital in Houston presented a 24-month chart review of 23
episodes of gastrointestinal cryptosporidiosis in 12 patients who
were treated with paromomycin. All the patients showed some
degree of symptom improvement after receiving the antibiotic, and
in seven patients' stools the organism became undetectable.
Minimal toxicity was reported. The dosing ranged from 1500 to
2000 mg daily, for a median duration of two weeks.
Loperamide, marketed as an antidiarrheal under the trade
name Imodium, and the investigational somatostatin analogs were
discussed as attempts to control AIDS-related diarrhea, and not
as a cryptosporidia treatment per se. Managing the debilitating
symptoms of diarrhea and weight loss of cryptosporidiosis is a
critical measure, though only a stop-gap one.
Meanwhile, a truly effective treatment for eradicating this
infection is urgently needed.
References
The Conference tape of Dr. Soave's presentation is tape #90ICA-
63. (For information on ordering Conference tapes or abstracts,
see "Obtaining Conference Information," below.)
The following references are to the three-volume set of abstracts
of the Sixth International Conference on AIDS:
Gathe, J and others. Treatment of gastrointestinal
cryptosporidiosis with paromomycin. Park Plaza Hospital,
Houston, Texas. Abstract #2121.
Girard, PM and others. Preliminary results of Vapreotide (a new
somatostatin analog) in AIDS related diarrhea. Hopitaux Bichat-
C Bernard, Necker, St Antoine, Paris, France. Abstract #Th.B365.
Hojlyng, N and others. Cryptosporidium diarrhoea in AIDS
patients treated with hyperimmune bovine colostrum. Statens
Seruminstitut, Copenhagen, Denmark. Abstract #Th.B. 521.
Mallolas, J and others. Efficacy and tolerance of SMS 201-995 (a
somatostatin analog) in HIV infected patients with diarrhea.
Hospital Clinic, Barcelona, Spain. Abstract #Th.B. 364.
Mukololo, P and others. Efficacy of loperamide oxide in HIV-
related diarrhoea. University Teaching Hospital, Lusaka, Zambia.
Abstract #2025.
Soave, R and others. Oral diclazuril therapy for
cryptosporidiosis. Cornell Medical Center, New York University
and St. Luke's/Roosevelt, New York. Abstract #Th.B. 520.
Announcements
Michelle Roland to Write for AIDS TREATMENT NEWS
Michelle Roland, well known among AIDS treatment activists
in San Francisco, will contribute occasional articles to AIDS
TREATMENT NEWS, starting with this issue.
Ms. Roland has worked with ACT UP/San Francisco since 1987,
and with its Treatment Issues committee since last year. She has
worked with NIH and FDA officials on issues of drug development
and regulation.
She also worked as interviewer for a year and a half for the
Biopsychosocial AIDS Project, University of California San
Francisco, and presented a poster on this work at the 1989 AIDS
conference in Montreal.
Ms. Roland is currently a medical student at the University
of California, Davis, and is student coordinator at the Medical
Center AIDS Clinic there. She is spearheading an effort to
create an AIDS curriculum for medical students -- a curriculum
which could become a national model.
She is also developing a computer model which might be able
to replace placebo controls in certain clinical trials.
Obtaining Conference Information
The most important reference from the Sixth International
Conference on AIDS is the three-volume set of abstracts. The set
costs $50. To order a copy, call the Sixth International
Conference, 415/550-0880.
The papers deemed most important by the Conference
organizers were given time for oral presentation. Audio tapes of
the sessions can be ordered from Professional Programs, Inc.,
12035 Saticoy Street, Suite B, North Hollywood, CA 91605, phone
818/764-7087, fax 818/764-7658. Tapes cost $8.50 per cassette;
postage in the U. S. is $1.50 per tape, $15 maximum postage per
order; overseas airmail postage is $2 per tape ($4 minimum
postage) with no maximum. You can order individual tapes by
number, or obtain an order blank to make selections. Note that
most sessions are on two cassettes.
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