kdavis@apple.com (Ken Davis) (06/02/89)
AIDS TREATMENT NEWS #80, June 2, 1989 CONTENTS Cryptosporidiosis: Important Treatment Advance? Itraconazole: Affordable Fluconazole Substitutes? San Francisco: Hypericin, Ozone Monitoring Projects Begin How to Use Hypericin Cimetidine (Tagamet) As Immunomodulator, Antitumor Agent? Foscarnet Organizing: New Phone Number Book Review: Epidemic Politics Under Microscope Hypericin Survey CRYPTOSPORIDIOSIS: IMPORTANT TREATMENT ADVANCE? by John S. James AIDS TREATMENT NEWS has heard credible rumors that a new drug used to kill parasites in animals might be effective for treating cryptosporidiosis, a serious opportunistic infection which causes severe diarrhea in persons with AIDS. The drug, diclazuril (trade name Clinacox), kills parasites and their cysts in chickens, when added to their feed in as lit- tle as one part per million, or when given as a single dose of 5 mg/kg. We have heard that a few people have used diclazuril in Africa and in the United States, and that a dose of 200 mg per day or slightly more may completely eliminate cryptosporidiosis in many cases, killing both the organism and the cysts in a few days. However, the drug is not approved anywhere for human use, and we have not yet confirmed that the 200 mg dose is safe or effective. And no one is sure how long the treatment may need to be continued. We do not know in which countries diclazuril is currently marketed for agricultural use. We decided to publish this short article, despite the frag- mentary information, so that others can help us investigate and learn more. If you have any information about diclazuril, please contact John James at AIDS TREATMENT NEWS, 415/255- 0588, or by mail. References No human research has been published. We obtained the fol- lowing references by computer searches and have not yet seen the articles. Animal Pharm World Animal Health News : Number 139, page 18, October 9, 1987; Number 140, pages 8-9, October 23, 1987; Number 166, page 14, November 4, 1988; Review issue, page 14, January 6, 1989. Jensen, JF. Comparison of the new coccidiostat diclazuril and an approved coccidiostat in research with broilers (English transla- tion of Danish title). Statens Husdyrbrugsforsoeg, number 724, October 6, 1988. Kutzner, E and others. Diclazuril, a new anticoccidial agent for broilers (English translation of German title). Wiener Tierarztliche Monatsschrift, volume 75 number 11, pages 415- 419, 1988. Maes, L and others. In vivo action of the anticoccidial diclazu- ril (Clinacox) on the developmental stages of Eimeria tenella: a histological study. J. Parasitol volume 74 number 6, pages 931- 938, December 1988 Mathis, GF and others. Anticoccidial efficacy of diclazuril in chickens. 77th Annual Meeting of the Poultry Science Association, Inc. Poult Sci 67 (supplement 1), 115, 1988. Verheyen, A and others. In vivo action of the anticoccidial diclazuril (Clinacox) on the developmental stages of Eimeria tenella: an ultrastructural evaluation. J Parasitol, volume 74 number 6, pages 939-949, December 1988. ITRACONAZOLE: AFFORDABLE FLUCONAZOLE SUBSTITUTE Fluconazole is a very good antifungal which is taken by mouth; it is effective for cryptococcal meningitis and many other fungal infections. It is approved in England, but not in the United States, apparently because of bureaucratic snafus. Some people have obtained personal supplies from England, but the drug is very expensive; maintenance doses for cryptococcal meningitis can cost almost as much as AZT, and insurance will not pay for fluconazole because it is not approved. Another drug, itraconazole (brand name Sporanox) may be almost as good as fluconazole but much less expensive. Itracona- zole is used to treat many different fungal diseases. It may be less effective than fluconazole for cryptococcal meningitis, how- ever, although it is sometimes used for that condition (see references, below). Itraconazole is available in Mexico, and it either is or is soon expected to be available in the UK. We do not have exact price information, but have heard that treatment with itraconazole (obtained from Mexico) costs about $1.50 to $3.00 per day, depending on the dose. Anyone considering using fluconazole or itraconazole should also consider the more conventional options. Amphotericin B (AMB), which is readily available, is probably at least as effec- tive as fluconazole. Its drawbacks are that it must be given intravenously, it can cause unpleasant side effects, and some patients cannot tolerate it at all. If AMB cannot be used, a patient may be able to qualify for a trial of fluconazole, or for compassionate use, in which case the drug will probably be free. Physicians only who want to find out how to enroll their patients should call the developer, Pfiser Inc., at 203/441-4112. If these options do not work, then for more information about obtaining fluconazole or itraconazole from abroad, patients can call the PWA Health Group, 212/532-0280. References De Gans, J and others. Itraconazole as maintenance treatment for cryptococcal meningitis in the acquired immune deficiency syn- drome. British Medical Journal 296/6618 (339), 1988. Dismukes, WE. Azole antifungal drugs: old and new. Annals of Internal Medicine volume 109 number 3, pages 177-179, August 1, 1988. Dupont, B. Attack and maintenance cure of cryptococcal meningitis in AIDS patients. (English translation of French title.) Med. Mal. Infect., volume 18, special issue 215, pages 737-741. Saag, MS and Dismukes, WE. Azole antifungal agents: emphasis on new triazoles. Antimicrobial Agents and Chemotherapy volume 32 number 1, pages 1-8, January 1988. Tucker, RM and others. Treatment of mycoses with itraconazole. Annals of the New York Academy of Sciences number 544, pages 451-470, 1988. Wishart, JM. The influence of food on the pharmacokinetics of itraconazole in patients with superficial fungal infection. Jour- nal of the American Academy of Dermatology volume 17 number 2 part 1, pages 220-223, August 1987. SAN FRANCISCO: HYPERICIN, OZONE MONITORING PROJECTS BEGIN San Francisco area community groups have begun two small, prospective monitoring studies to collect reliable information about potential AIDS/HIV treatments which have come into use by patients but are not being studied in formal clinical trials. "Monitoring" studies do not give treatment to anyone; they only collect data. Therefore they are much easier to set up and administer than the large-scale, randomized trials favored by large institutions. "Prospective" means that these monitoring studies are designed in advance, allowing clean, uniform data gathering: the same blood tests for every patient, on the same schedule and at the same lab; uniform physical examinations, med- ical history interviews, and patient diary forms; and an overall study design approved in advance by a scientific committee. If successful, these studies can serve as precedents for rapid, community-controlled research projects to get reliable data for patients and physicians, as soon as new treatments come into use. THE HYPERICIN STUDY We have previously reported on hypericin, an antiretroviral found in St. John's wort, a plant long used in herbal medicine (see AIDS TREATMENT NEWS #63, 74, 75, 77, and 78). While main- stream researchers are synthesizing the chemical, running animal studies, and negotiating for FDA permission to begin "phase I" human trials this year or next, probably hundreds of people are already using herbal extracts. We are hearing anecdotal reports of benefits, but this information is inherently limited because of unknown self-selection biases, and because different blood tests and different labs were used. The new monitoring study, formally approved May 22 by San Francisco's Community Research Alliance (CRA; for background on this community-based research organization, see AIDS TREATMENT NEWS issue # 70, December 1, 1988), is for people who have not used hypericin in the last six months, but plan to start using a standardized herbal extract. (Standardized extracts are those which have been chemically tested during their manufacture and adjusted to contain a uniform strength of an active ingredient in every batch. Examples of St. John's wort extracts standardized for hypericin content are Yerba Prima tablets, Psychotonin tinc- ture, and Hyperforat tincture.) The study will last four months. "Baseline" testing (before treatment begins) includes P24 antigen, T-cell subsets, CMI, Beta 2 microglobulin, CBC, ESR, and SMA 25, as well as a physical examination and medical history. Blood tests are given monthly; the last visit includes a second physical exam. A total of five monthly visits is required. All tests are paid for by the CRA. At this time, the CRA has enough money to enroll 30 patients. More will be enrolled if the money can be raised. Note: Ten patients per month will be enrolled in this obser- vational study. If you are interested in volunteering, call the Community Research Alliance at 415/626-2145. If more than ten qualify for the study, ten will be chosen by a lottery; those not chosen the first month will be considered again at later months. The first ten may be able to start by late June. However, no starting date can be guaranteed, and there will probably be more volunteers than can be accepted. It is very important that people who enter this study have not used hypericin in the previous six months. Otherwise, bene- fits may have already occurred before the first physical exam and blood test, and therefore the study would miss them and mislead- ingly underestimate the value of the treatment. All other treatments (AZT, etc.) are OK, however, either before or during the study. One of the rules of a monitoring study is that it does not ask people to change the treatments they would be using anyway. These must be reported to the researchers, of course. The Community Research Alliance is also looking for volunteers for office work, etc. If you can help, call the number above. Ozone Study Ozone is being studied as an AIDS/HIV treatment in Germany, but aside from a small trial for AIDS-related diarrhea at the Veterans Administration Hospital in San Francisco, there are no government or corporate clinical trials in the United States. Recently, however, a group of ten persons with AIDS or HIV jointly purchased an ozone machine for their own use, and before beginning the treatment they organized their own monitoring study, with the help of research nurse Leland Traiman. Mr. Trai- man runs mainstream AIDS clinical trials professionally, and he volunteered to help coordinate the patients' ozone trial. This eight-month study includes the same blood tests as the hypericin protocol described above. (These tests are becoming a core subset of uniform blood work and data collection forms, to be used in many prospective monitoring studies.) Laboratory work, medical history, and physical exams were given before treatment started, to obtain baseline values; eight additional appointments were scheduled over the next eight months. The baseline and two other blood drawings have already occurred; the fourth blood draw is scheduled for the end of May. At this time, the ozone trial is not officially sponsored by any organization; it belongs entirely to the people in the study. When they obtained the ozone machine, the Community Research Alliance was newly organized and not ready to approve and admin- ister a study. But the patients were ready to start, and of course they did not want to wait for a study. So the Healing Alternatives Foundation (the San Francisco buyers' club) donated $2500. for initial blood work; without that support at a critical time, the baseline values could not have been obtained and the study would have been lost. The entire trial will cost about $10,000, almost all of it for lab work, as Mr. Traiman's time is volunteer. Money from an anonymous benefactor, from AIDS TREAT- MENT NEWS, and from Mr. Traiman himself has kept the study going so far. Recently the Berkeley Gay Men's Health Collective offered to assist, by housing the ozone monitoring project in the Berkeley Free Clinic building. After seven weeks of ozone treatment, no dramatic changes have been found. At three weeks, lymphocyte counts had improved substantially for many of the patients; other blood work showed no meaningful change. By the seventh week, however, these counts had returned to close to their baseline values. At this time there is no evidence of any benefit, or of any harm, from the ozone treatment. The lack of early results does not discourage Mr. Traiman. "There are no conclusive results so far; it's too early to tell... I don't believe or disbelieve that ozone is an effective therapy. I've heard some strong positive anecdotal reports, and I want to learn if there is any scientific basis behind them." A New Model for Community Response? One of the most successful responses to the AIDS epidemic so far has been the "San Francisco model", close cooperation between public agencies and private, mostly volunteer organizations, in providing prevention education and services to those who are ill. However, this model has traditionally not included any involve- ment with research. The ozone and hypericin studies suggest a new, additional model for the years ahead. Small but well-conducted research stu- dies are within the capabilities of grassroots organizations. The key test of the success of these projects is whether they produce information which is credible to front-line AIDS physicians, and useful to patients and physicians alike in making treatment deci- sions. Community groups responsive first and foremost to patients' interests can move much faster than Federal or cor- porate bureaucracies ever will; if they can generate solid treat- ment information, they will make a major contribution to saving lives and improving quality of life. These small studies which combine the work of professionals, activists, and other volunteers are also relevant to public pol- icy in a time of scarce resources. Monitoring studies cost very little to run. If they produce useful treatment information, they should pay for themselves many times over, by reducing the need for hospitalization and other treatment, by keeping people pro- ductively employed instead of ill, and by developing very low cost treatment options (such as hypericin herbal extracts) which other U.S. research institutions seldom or never do. HOW TO USE HYPERICIN by John S. James AIDS TREATMENT NEWS has published several articles and updates on hypericin, an antiviral available in extracts of the St. John's wort plant (see AIDS TREATMENT NEWS numbers 79, 77, 75, 74, and 63). Almost all the reports we are hearing from users are good, a fact not always reflected in our articles, as we have felt obligated to publish reports of side effects or possible dangers immediately, but have not hurried into print with the reports of benefits. Few people who have told us about their use of hypericin have failed to report benefits, usually objective improvements in symptoms, blood-test results, or both, often entirely unexpected. However, we have only received about 25 reports overall, and it is possible that we have seen a biased picture because persons who did not see any effects may not have bothered to contact us. We hope that the survey elsewhere in this issue will help to correct such bias. And the upcoming prospec- tive monitoring study by San Francisco's Community Research Alli- ance (also described in this issue) should obtain better informa- tion than any survey could. There has also been confusion about how to use hypericin. We have reported several different dosage regimens, and different brands. AIDS TREATMENT NEWS has a policy against making its own treatment recommendations; but we have closely followed the use of hypericin herbal extracts, and since little information is available, we decided to summarize the picture as we see it. The following three standardized extracts contain signifi- cant amounts of hypericin: Yerba Prima St. John's wort tablets, Psychotonin tincture, or Hyperforat tincture. "Standardized" means that the concentration should be uniform from batch to batch. Of the three, the Yerba Prima tablets are much less expen- sive than the other two, which must be imported from Germany. As far as we know, the tablets are just as good. AIDS TREATMENT NEWS had a chemist test several brands, as we previously reported. Two other products, St. John's wort tinc- tures from Herb Pharm and from Jarrow Formulas, were found to contain comparable amounts of hypericin. These products are not standardized for hypericin content, however, so the concentration may vary. Not acceptable are products which have not been indepen- dently tested. As there are no standards for herbal products in the United States, a product can be labeled "St. John's wort" no matter how little St. John's wort or hypericin it contains. Even some European extracts may have ten times less hypericin as the products we named above. We could not test everything, however, and other products we do not know about may also be good. Also not acceptable are teas made from dried St. John's wort, which is sold in health-food stores. As previously reported, we have heard of little or no benefits from these teas, and one report of possible harm. Hypericin may be especially effective for persons who are also using AZT. What about the dose? For the Yerba Prima tablets, with which we are most familiar, the usual dose is two or three of the 250 mg, 0.14 percent hypericin tablets per day. Some people are using as many as six tablets every day. (The dose recommended on the bottle is two.) There are also intermittent schedules being tried, in which the tablets are not used every day. Absorption and blood-level studies are now being done, with hypericin being administered intravenously, intramuscularly, and orally. Dose recommendations may change in the future. AIDS TREATMENT NEWS will report information as it develops. The most important safety precaution, in our view, is to have liver function tests (often included in a blood-chemistry panel) within several weeks of starting hypericin. In a handful of cases, persons using hypericin have been found to have elevated transaminase values, and their physicians had them stop all treatments which might have been responsible. While no one is sure that St. John's wort caused the problem, it would be unsafe to take risks until more is known. Another precaution is to avoid exposure to sunlight or ultraviolet light. Photosensitivity (abnormal sensitivity to sun- light) due to St. John's wort extracts has been so rare in humans that there is debate about whether it happens at all. But again it seems better to err on the side of safety. Drowsiness has been reported when people have used large doses of hypericin-containing extracts. One conservative strategy for using hypericin would be to continue it only if there are clear benefits. In most of the reports we have heard, unmistakable improvements in symptoms and/or blood work were seen within a few weeks. One approach to risk reduction would be to accept the probably small risks of the treatment provided that there is clear benefits to balance the risk, but to discontinue use if there was no evidence that it was helping. CIMETIDINE (TAGAMET) AS IMMUNOMODULATOR, ANTITUMOR TREATMENT? by Denny Smith Cimetidine (Tagamet), commonly used to treat stomach ulcers and one of the most widely prescribed drugs in the U.S., has shown immune enhancing and antitumor activity in recent studies. In its original use, cimetidine worked by blocking the receptors on stomach cells which control digestive acid secretions. Cimetidine has also been shown to be useful for controlling herpes simplex and herpes zoster outbreaks, as well as chronic Epstein-Barr infection. (Cimetidine can slow the metabolism of other drugs, leading to increased concentrations of them in the bloodstream. This is important for drug interactions/half-life considerations.) The results of the current studies demonstrated variously that cimetidine appeared to increase in vitro the proliferation and potency of lymphocytes, probably by stimulating interleukin-2 production; increased the median survival time of patients with gastric cancer and possibly lung cancer as well; enhanced natural killer activity in patients with leukemia; and reduced T8- suppressor cell activity in patients with hypogammaglobulinemia. The most interesting research relating to HIV was done at the University of Essen in West Germany. 1200 mg of cimetidine was given daily to 33 patients with ARC for five months. All of the participants showed improvement of symptoms, such as decreased fevers, diarrhea and lymph node size, and increased body weight and sensitivity to skin antigen tests. Significant increases in several immune functions were noticed, including elevated T- helper cell counts. These effects were reversible when cimetidine was stopped, and reproducible when resumed. We spoke with S. Jeanne Bramhall, M.D. who conducted her own informal cimetidine monitoring project with five patients in Seattle. All five patients experienced relief from a number of AIDS or ARC symptoms, apparently after several weeks of Tagamet, 300 mg three times daily. Here is a brief summary of the results: Patient 1: After three weeks on Tagamet and imipramine, her fatigue, night sweats and lymphadenopathy disappeared completely. These symptoms returned when the patient stopped the Tagamet, and disappeared again when she resumed. Her T-cell ratio returned to normal and the symptoms did not recur when she discontinued the Tagamet after a second three-month trial. This patient has since been lost to follow-up. Patient 2: Experienced relief of disseminated herpes lesions and thrush after two weeks of Tagamet, and after three months a diagnosed Kaposi's sarcoma lesion in his mouth vanished. His T- cell ratio was improving after eight months, and he had added amitriptyline, acyclovir and ketoconazole to his medications. He also wanted to start AZT, but was apprehensive about the poten- tial for cimetidine to increase the toxicity of certain drugs. To avoid this he replaced Tagamet with ranitidine (Zantac), a related drug which studies found somewhat as active as an immu- nomodulator but less likely to potentiate the toxicity of other drugs. After switching he suffered several bouts with a per- sistent staph infection and two episodes of PCP. He was also lost to follow-up. Patient 3: Started Tagamet after hospitalization for pneumo- cystis. He noticed increased energy levels and diminished oral thrush and enrolled in a local AZT study. After three months the AZT had caused anemia severe enough to warrant a transfusion (bone marrow toxicity is not unusual with AZT but perhaps the potential for toxicity was enhanced with Tagamet). He elected to discontinue both medications and after a month the anemia was corrected. He now takes no medication other than Chinese herbs, but seven months after the Tagamet he has seen four KS lesions subside and has gained 25 pounds. Patient 4: After a month on Tagamet, his persistent leuko- plakia, intermittent fevers and diarrhea all subsided. After five months, he discontinued the Tagamet and megavitamins, thinking that they were causing a recurrence of diarrhea. At the time he was lost to follow-up, he was not on any medication and had remained symptom-free. Patient 5: Fatigue decreased dramatically after one week on Tagamet, but oral thrush persisted until he increased the dose to 400 mg three times a day for a week. He discontinued Tagamet and continues to be in good health. Dr. Bramhall is not a researcher and did not have access to substantial funds or resources. But her anecdotal results should be a springboard for more and larger studies. She points out that cimetidine is relatively a very safe drug and is available now to people with HIV and their physicians. Our thanks to Dr. Bramhall for her work and to Jonathan Lax and Jim Tavitian for helpful information. We hope to find more information on this potential treatment at the V International AIDS Conference in Montreal. References Brockmeyer, NH and others. Immunomodulatory properties of cimetidine in ARC patients. Clinical Immunology and Immunopathol- ogy, number 48, pages 50-60, 1988 Tonnesen, H and others. Effect of cimetidine on survival after gastric cancer. The Lancet, October 29, pages 990-991, 1988. Gifford, RRM and Tilberg, AF. Histamine type-2 antagonist immune modulation II. Cimetidine and ranitidine increase interleukin-2 production. Surgery, volume 102, number 2, pages 242-247, August, 1987. Allen, JI and others. Cimetidine modulates natural killer cell function of patients with chronic lymphocytic leukemia. Journal of Laboratory Clinical Medicine, volume 109, number 4, pages 396-401, April 1987. White, WB and Ballow, M. Modulation of suppressor-cell activity by cimetidine in patients with common variable hypogammaglobu- linemia. The New England Journal of Medicine, volume 312, number 4, pages 198-202, January 24, 1985. Armitage, JO and Sidner, RD. Antitumour effect of cimetidine? The Lancet, pages 882-883, April 21, 1979. FOSCARNET ORGANIZING: NEW PHONE NUMBER On December 16, 1988 AIDS TREATMENT NEWS published a San Francisco phone number as a contact for organizing to make fos- carnet an available treatment option in the United States. The number belonged to Terry Sutton, who died on April 11 without receiving the drug (see "Terry Sutton, 1955 - 1989", AIDS TREAT- MENT NEWS #77). The new contact number for foscarnet organizing is 415/431- 6088. Note: In our talks with U.S. physicians who are experienced with foscarnet, they have emphasized that it is not a miracle drug for CMV, or as an HIV treatment; most prefer ganciclovir for CMV. Physicians are much more concerned that foscarnet is no longer available through compassionate use for treating acyclovir- resistant herpes, for which it seems clearly better than anything else available. BOOK REVIEW: EPIDEMIC POLITICS UNDER MICROSCOPE by Denny Smith AIDS: Cultural Analysis/Cultural Activism, edited by Douglas Crimp, is an excellent anthology published by MIT Press last year and available in its second printing this year. Fourteen essays examine the culture of contempt and disinformation which has shaped the character of AIDS in America. Four essays recommended in particular are: "AIDS, Homophobia, and Biomedical Discourse: An Epidemic of Signification", by Paula A. Treichler; "AIDS and Syphilis: The Iconography of Disease", by Sander L. Gilman; "Is the Rectum a Grave?", by Leo Bersani; and "How to Have Promiscu- ity in an Epidemic", by the editor. Treichler writes: "The 'free-floating' iconography of disease attaches itself to various illnesses (real or imagined) in different societies and at different moments in history. Disease is thus restricted to a specific set of images, thereby forming a visual boundary, a limit to the idea (or fear) of disease. . . the 'taming' of syphilis and other STDs with the introduction of antibiotics in the 1940s left our culture with a series of images of mortally infected and infecting people suffering a morally repugnant disease--without a sufficiently powerful disease to function as the referent of these images. . . AIDS appeared then as the perfect referent." In the following passage Douglas Crimp quotes Senator Jesse Helms in the right-wing lawmaker's effort to foment support for an amendment to deny Federal funds for gay safe sex education. " . . . about 10 days ago I went down to the White House and I visited with the President. I said, 'Mr. President, I don't want to ruin your day, but I feel obliged to hand you this and let you look at what is being distributed under the pretense of AIDS educational material . . .' "The President opened the book, looked at a couple of pages and shook his head, and hit his desk with his fist." The book in question was "precisely the sort of safe sex education material that has been proven to work, developed by the organization (Gay Men's Health Crisis) that has produced the greatest amount of safe sex education material of any in the country, including of course, the Federal government . . . when we see how compromised any efforts at responding to AIDS will be when conducted by the state, we are forced to recognize that all productive practices concerning AIDS will remain at the grass- roots level." HYPERICIN SURVEY If you have used hypericin (St. John's wort extracts), or know anyone who has, whether or not any results were seen, you can help with this survey. All identifying information will be kept confidential. Please complete this questionnaire even if you have already told us about your use of the treatment. Use the back of this sheet, or use additional paper, when- ever necessary. Please print or type. A. Initials of person using hypericin: (Optional--you may omit this information. If you provide it, we will keep it confidential. We are requesting it to help us avoid counting the same person more than once.) First initial _____ Last initial _____ State of residence (or country if not U.S.) _____ B. Hypericin preparation used (circle one or more): Yerba Prima tablets Psychotonin tincture Hyperforat tincture Jarrow Formulas tincture Herb Pharm tincture Other (please specify) _______________ C. What daily dose was used? (Specify tablets, drops, or other. Explain on back if necessary.) _____ D. How long was it used, in weeks? _____ (Explain on back if necessary.) E. Benefits which you believe might have been due to hypericin: (Use back of sheet if needed.) F. Side effects or harm which you believe might have been due to hypericin: (Use back of sheet if needed.) G. Symptoms or conditions which failed to improve while you used hypericin: (Use back of sheet if needed.) H. P24 antigen levels, if available: Before starting hypericin (include date of blood drawing) _____ After using hypericin (include number of weeks of treatment use at time of blood drawing) _____ I. T-helper cell counts, if available: Before starting hypericin (include date of blood drawing) _____ After using hypericin (include number of weeks of treatment use at time of blood drawing) _____ J. Other treatments: AZT (circle one: yes / no). Dose: _____ Other antivirals (please specify, and give dose): _______________ Other treatments we should know about (please list): K. Optional: If we can contact you in case we have any further questions, please give us your name and phone number: L. In your own words, what do you think of hypericin? Also, use this space to tell us anything else we should know. STATEMENT OF PURPOSE AIDS TREATMENT NEWS reports on experimental and complemen- tary treatments, especially those available now. It collects information from medical journals, and from interviews with scientists physicians, and other health practitioners, and per- sons with AIDS or ARC. Long-term survivors have usually tried many different treat- ments, 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. HOW TO SUBSCRIBE TO AIDS TREATMENT NEWS Send $100. per year for 26 issues ($150. for businesses and organizations), or $30. reduced rate for persons with AIDS or ARC who cannot afford the regular rate, to: ATN Publications, P.O. Box 411256, San Francisco, CA 94141. A six-month subscription (13 issues) is $55. ($80. for businesses or organizations), or $16. reduced rate. For subscription information and a sample issue, call (415) 255-0588. For the complete set of over 70 back issues, send $75. ($18. for persons with AIDS or ARC) to the above address. The back issues include information on hypericin, dextran sulfate, foscarnet, passive immunotherapy, DTC (Imuthiol), naltrexone, DHEA, len- tinan, propolis, coenzyme Q, monolaurin, egg lecithin lipids, fu zheng herbal therapy, DNCB, aerosol pentamidine, fluconazole, ganciclovir (DHPG) and other experimental or complementary treat- ments. To protect your privacy, we mail first class without mentioning AIDS on the envelope, and we keep our subscriber list confiden- tial. Outside North America, add $20. per year for airmail postage, and $18. airmail for back issues. 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. Copyright 1989 by John S. James. Permission granted for non- commercial reproduction. -- Ken Davis - W6RFN San Francisco, California UUCP: (apple, pyramid, netsys, pacbell, hoptoad}!lamc!kdavis DIALCOM: 164:MDU0116