+----------------------------------------------------------------+ | AIDS TREATMENT NEWS No. 144 - February 7, 1992 | +----------------------------------------------------------------+ copyright 1992 by John S. James; permission granted for non-commercial use. Note: This issue went to press before the FDA asked the buyers' clubs to discontinue sale of ddC. We will have an in-depth report in our next issue. CONTENTS: [items are separated by "*****" for this display] Experimental Viral Tests for HIV Disease Progression Disability Regulation Problems: Public Comment Deadline February 18 Melanin: Negative Reports FDA Tests Buyers' Club ddC AZT: European Study Stopped, Disease Progression Reduced International AIDS Conference: Abstracts Due March 2, "Alternative" Abstracts Sought Clinical Trials Design Conference, March 5-6, San Francisco Correction: Chicago Buyers' Club Phone Number AIDS TREATMENT NEWS Staff Changes ***** Experimental Viral Tests for HIV Disease Progression by John S. James A book recently published in France -- Viral Quantitation in HIV Infection, edited by Jean-Marie Andrieu -- provides a technical but understandable background on the state of the art of measuring HIV levels in humans (and also in animal and laboratory studies). The book presents the proceedings of the International Workshop on Viral Quantitation in HIV Infection, June 13-24, in Paris; it is entirely in English, the language of the conference, although more of the research presented was from France than from any other country. For several reasons it is important for AIDS activists, medical professionals, and others involved with the epidemic -- not only scientific specialists -- to understand what is happening in the development of better tests for HIV disease status and progression: * Better "surrogate markers" of disease status are critically important for designing faster, more feasible, and less expensive trials of new drugs. Early clinical trials to test drug efficacy were set up to run for years, because they looked for statistical differences in death or disease progression. More recently, T-helper counts have become generally accepted as an indicator of disease progression -- but only for one class of drugs, nucleoside analogs such as AZT, ddI, and ddC. And T-helper counts are highly variable and have other drawbacks. Today it appears that a better surrogate marker for drug trials -- proportion of T-helper cells which are infected by HIV (see description below) -- might be feasible. But experience has shown that improvements in AIDS drug testing and in treatment do not happen automatically. Activists must understand them and push for them. * The same tests which could allow faster drug trials could also be important for improving the treatment of individual patients. For example, the test mentioned above -- proportion of HIV-infected T-helper cells -- may be a good prognostic indicator, showing who is likely to progress to serious illness well before T-helper cells start to decline. These patients may want to start more aggressive treatment early, while those with a better prognosis might choose a more conservative approach. * Another use for such tests would be to monitor treatments, telling which ones are working for which patients. HIV disease is very different in different people, so no one treatment will fit everybody. Treatments could be selected based on their efficacy for a particular individual, then discarded if they later stop working. (T-helper counts are already used for this purpose, but this measurement is a crude one.) * Better tests for disease progression could have public- health importance in the campaigns beginning now to get people into early treatment for HIV infection. Better targeting of early treatment could reduce the cost and increase the effectiveness of these programs, making it easier to get them funded. Better targeting could also make early treatment more attractive to patients, since they would receive AZT or other drugs only when laboratory tests showed that they clearly needed them. * Better viral testing could make it easier to screen the various "alternative" treatments -- those without pharmaceutical-company or government sponsorship -- which have come into popular use without official approval. The nutritional, herbal, and other treatments which have become widely used have usually been fairly safe and relatively inexpensive -- some have been called the "why not" drugs -- and usually they have some scientific rationale. The problem is that usually there is little or no hard evidence that they actually work as AIDS/HIV treatments in people. The great expense of clinical trials has made it very difficult to finance careful trials of substances which are unpatentable, or are otherwise commercially unattractive. (And this same expense all but guarantees that when a pharmaceutical company does develop a drug, the eventual price will exclude most of the world's population.) Better ways to tell how well a drug is working would make trials more precise, more credible, and less expensive. And even if trials of non-commercial products still could not be financed, better information about drug efficacy would give physicians a better practical sense of what is working and what is not. Dozens of "alternative" treatments are now in use. If even a few were clearly found to be useful, they could be immensely important. * The new book on viral quantitation was published in Europe, with no U. S. distributor, so it may not be widely seen in this country. Some of the leading U. S. experts on viral measurement attended the conference to present their own results, and they will be familiar with the state of the art in this field. But it is also important that front-line physicians, activists, and organizers involved with AIDS policy understand this field, and the new testing options which may become available. Because of the ongoing lack of U. S. political leadership on AIDS, there is no one in a position to survey the technological advances and develop national policy to respond to the new opportunities and make sure that important leads are effectively followed up. Activists, by default, have had to take on this job and do what they can. Viral Quantitation in HIV Infection is divided into three sections. The first, on quantifying HIV by using viral cultures, consists of ten research papers. The second, on animal research, has three papers. The third, on using PCR (polymerase chain reaction) to measure HIV, has eight papers. Instead of trying to summarize all this research, we will describe one report which may be very important. Measuring the Proportion of T-Helper Cells Which Are Infectious A paper by JM Andrieu, G Manolikakis, and W Lu, of the Laboratory of Tumor Immunology at the University of Paris, is titled "Clinical Application of Viral Quantitation by Measuring the Frequency of Infectious Virus-Harboring Cells in Blood Samples of HIV-1 Seropositive Individuals." The basic idea, that the proportion of T-helper cells which are infectious in viral cultures can be a useful measure of disease status, is not new; considerable research has already been published. But Andrieu and colleagues claim to have improved and simplified the procedure; they are proposing a practical, potentially standard method by which different clinical laboratories could monitor patients with HIV infection and obtain comparable data. When they tested their method with 38 selected asymptomatic patients, some monitored for up to two years, they found that the proportion of T-helper cells which were infective almost invariably distinguished those who remained stable from those who were later found to progress -- even though there was little initial difference between these groups in T-helper counts. (Other results from patients with symptomatic illness or AIDS were also reported, including data showing limited response to AZT therapy in the group overall -- but also showing that some patients had a very good, and continuing, response to the AZT.) Comment It should not be surprising that the proportion of T-helper cells which are infected would be a better measure of disease status than the T-helper count. The count depends on many factors, such as time of day, exercise, other illnesses, and probably many unknown factors as well. The proportion of cells infected by HIV is a much more specific measure of the progression of HIV disease. The paper does leave some questions unanswered, so other scientists will need to get details from the authors. For example, the 38 asymptomatic patients were "selected," but the paper does not tell how they were selected. And ten of these patients progressed to AIDS and three to ARC in a mean follow-up of 18 months, despite the fact that these 13 patients started with a mean T-helper count over 500 (The other 25 patients remained stable -- although seven of them did cross the cut- off line of more than one in ten thousand T-helper cells being infectious, indicating that they were at risk for progressing in the future.) Perhaps the fact that all 38 patients had to be ones from whom the virus could be cultured caused this group to have a worse prognosis than would usually be expected; however, this issue is not explained in the paper. [Other researchers have been able to culture HIV from blood cells of all patients with ARC or AIDS, and from a large majority patients who are asymptomatic and have high T-helper counts. See, for example, "Quantitation of Cellular Viral Load: Correlation with CD4 Cell Count, by A. Venet and others, also published in Viral Quantitation in HIV Infection.] Despite such questions, this very important study deserves to be followed up, not rejected out of hand. And since all the viral culturing done was from frozen blood cells, confirmatory studies by other groups might be done quickly, from samples already in freezers, without the need to start a new trial and then wait two years to see who progresses. Another bad reason to dismiss this research would be from misinterpretation of the modern realization that the classical theory of AIDS (that HIV infects and kills T-helper cells and thereby causes the immune deficiency) is incorrect -- and that the real pathogenesis of AIDS, the way the disease develops, is still unknown. Other cells -- such as macrophages, or cells in lymph nodes, or in other organs -- may well be more important than T- helper cells as sites of HIV infection. But even if the infection in T-helper cells is only an indicator of infection elsewhere, if this indicator works as a measurement to show who will progress to more serious disease, and whether particular drugs are effective, then that is what we need for now. We must use the tools we have and improve them later, instead of postponing practical science in order to wait for better theories. How to Buy the Book Viral Quantitation in HIV Infection is published by John Libbey Eurotext Limited, in Montrouge, France. The price is about $50, although it can change with international exchange rates; the best way to pay is by credit card. The book can be ordered from a distributor in England, Saber and Saber Limited, telephone 44-0279-417-134; or directly from the publisher in Montrouge, 33-1-46-57-10-09 (fax). It may be possible to request airmail delivery. ***** Disability Regulation Problems; Public Comment Deadline February 18 by John S. James The Federal Government is adopting a new definition of HIV- related disability which is expected to be effective for the next five years. The regulations will affect access to Medicaid and Medicare programs, as well as Social Security disability income under both SSI and SSDI. Unfortunately there are serious problems in the proposed regulations. You can help in making them better by writing to the address below during the public comment period, which ends February 18. (Additionally, organizations can sign on to a consensus letter being circulated by the Washington-based AIDS Action Council by February 14; for more information about signing on, call the AIDS Action Council at 202/293-2886 ext 18.) The proposed new regulations, published in the Federal Register December 18, 1991, pages 65702-65716, are in response to demands for reform of the current system, in which the Social Security Administration uses the AIDS definition of the U. S. Centers for Disease Control (CDC) in determining disability. Those who meet this early CDC AIDS definition are presumed to be disabled, and eligible for Supplemental Security Income (SSI) if they also meet financial requirements; others may be able to prove disability, but the process can be difficult and time- consuming. Because the CDC definition has been based on opportunistic infections common in men, women with comparably severe illness were often excluded, and often died of HIV disease before meeting the arbitrary definition of "AIDS. " But the new ways to qualify for disability still fail to include most of the conditions affecting women. Also, most of the new conditions which are included require "functional" tests to prove disability, in addition to the medical diagnosis. (Kaposi's sarcoma will also require the new functional tests; the other parts of the existing AIDS definition, such as pneumocystis, will continue to be accepted as proof of disability. But the new rules will often require invasive, expensive, or time-consuming tests to confirm these conditions, even when practicing physicians, as well as the CDC, do not regard these tests as necessary.) Ironically, the new proposal does acknowledge the different manifestations of AIDS in women -- but only as discussion about factors which adjudicators should take into account in deciding whether somebody qualifies as disabled. The problem is that almost none of these conditions are included in the formal "listings" -- meaning that the discussion will have little legal or practical effect. Most of the publicity about the new rules concerns the fact that one section lists having a T-helper count under 200, in addition to meeting other requirements, as qualification for disability. The AIDS Action Council agrees that a reasonable "functional" test of disability may be appropriate in this case, instead of considering someone disabled just because of a low T- helper count. The problem is that the functional tests are far from reasonable -- and that they are applied not only to persons claiming disability on the basis of blood counts, but to major medical diagnoses as well (see list below). Some of the problems are illustrated by the following list of conditions, in section 14.08 M(2) of the proposed rules: "Any one or more of the following, persistent and/or resistant to therapy: * pneumonia; * pulmonary tuberculosis; * bacterial or fungal sepsis; * meningitis; * septic arthritis; * endocarditis; * peripheral neuropathy; and * Kaposi's sarcoma." One or more of these conditions is not enough to qualify for disability unless the patient also meets at least two of four "functional" tests in addition. Other conditions which also require the functional tests (plus another medical condition in addition) include: anemia (hematocrit less than or equal to 30 percent); granulocytopenia (absolute neutrophil count less than or equal to 1,000); chronic or recurrent herpes zoster; persistent, unresponsive diarrhea; and persistent or recurrent radiographically documented sinusitis. To meet the additional "functional" tests of disability, the patient must have two or more of the following: "(a) marked restriction of activities of daily living; or (b) marked difficulties in maintaining social functioning; or (c) marked difficulties in completing tasks in a timely manner due to deficiencies in concentration or pace; or (d) repeated episodes of decompensation, averaging three times a year or once every fourteen months, lasting two or more weeks each, which cause the individual to deteriorate (which may include loss of adaptive functioning)." (The "marked" standard is defined to require an impairment "which seriously interferes with the ability to function independently, appropriately, and effectively.") It is clear that patients will become unemployable long before they meet these tests for disability income (and, in most cases, for access to Medicaid as well). Those who get their care at public clinics where they do not have private physicians, and often have long waits for any appointments, will be particularly disadvantaged -- especially since even those conditions such as pneumocystis or toxoplasmosis which do not require "functional" tests for disability determination cannot be "presumptively" diagnosed but will now require laboratory or other tests even in cases when physicians consider them medically unnecessary. Will public clinics pay for additional medical tests just to meet disability requirements? According to the AIDS Action Council, "These HIV-related conditions are the only physical conditions in all of the Secretary's adult listings that require a functional test to qualify for disability." Other problems with the new regulations include lack of gynecological conditions, except for stage II cervical cancer and recurrent vaginal candidiasis. Pelvic inflammatory disease is not included. What You Can Do Send your written comments to: Commissioner of Social Security, Department of Health and Human Services, P. O. Box 1585, Baltimore, MD 21203; they must arrive by February 18 to be counted. Persons with persistent or drug-resistant tuberculosis, pneumonia, or meningitis, for example, cannot be expected to work and should not have go to through difficult and time-consuming additional steps to prove that they are disabled. Tell the Social Security Administration how requirements like those listed above will affect you or your patients. The proposed regulations are not all bad, however, and the current system urgently needs reform. The regulations should be improved to reflect medical practice and common sense before being adopted. They should take into account the realities of medical care in public clinics, and not be designed in ways that in fact will virtually exclude most people who should qualify from receiving disability benefits and, in consequence, medical care. For more information, call the AIDS Action Council at 202/293-2886 ext 20; if you reach the voicemail, give your name and address and ask them to send information about the proposed disability regulations. ***** Melanin: Negative Reports by John S. James In AIDS TREATMENT NEWS #139, November 22, 1991, we reported about soluble melanins, a class of chemicals which showed anti- HIV activity in laboratory studies. We included several strikingly positive anecdotal reports from people who had tried the melanin, which is easy to synthesize in a chemical laboratory. Since that article, and an update in AIDS TREATMENT NEWS #141, which included one negative report, we have received only five new reports of melanin use. All of them, however, have been negative, that the treatment seemed to do nothing. (There has been no report of side effects, except from one person who stopped taking melanin because he thought it might be causing his peripheral neuropathy to get worse.) Some of the early positive reports continue to be positive. However, the person who was near death before starting melanin and had a notable recovery while on the treatment has since died. Apparently he discontinued the melanin after being advised to avoid unproven treatments; without more information, therefore, we cannot be sure that the death represents a treatment failure. Why would this treatment appear to work so well in some cases but not at all in others? No one knows, but there are at least four theories. One, from the chemist who first tried the treatment on himself, is that it seems to work best in people with HIV-related illness but no opportunistic infection. (If so, this pattern would fit with the theoretical picture that melanin may block gp120 or other toxic substance produced by HIV-infected cells.) Another theory is that melanin may be poorly absorbed from the digestive system, but absorbed better by some people than by others. The third theory is that different batches of melanins may not be the same -- with some being effective and some not. Melanins are endlessly variable, and in fact have never been fully characterized chemically. Since the exact chemical structure is unknown, it might not be possible to assure that different batches are identical. (One of the reports of failure was with melanin that the user made himself.) Another possibility, of course, is that the treatment does not work at all, that the early reports of improvement were due to coincidence. We still consider soluble melanins an important treatment possibility which deserves to be properly tested -- especially since there are few promising treatments at this time. But it is now clear that it will be harder to tell if melanin can be useful than had appeared to be the case after the early, positive results, when everybody who had tried the treatment reported dramatic improvement within days. Suggestion: A Low-Cost Study A rapid and low-cost way to investigate melanin further would be for a physician or other qualified medical professional to examine the medical records of the persons who have tried this treatment, examine the patients, and collect samples of the melanin for chemical study. In our reporting we have only taken the information volunteered, and not asked for medical details because we are not trained to take a medical history. What is needed is for someone who examines HIV patients every workday to try to find any pattern in the divergent results seen so far. If any credible project is organized to do this, we will call all our sources for these reports, and urge that they contact the project and cooperate with it. ***** FDA Tests Buyers' Club ddC On January 24 the U. S. Food and Drug Administration asked buyers' clubs in New York and San Francisco for samples of the experimental AIDS treatment ddC, in order to check the potency -- to make sure that each capsule contained the stated amount of ddC. Samples were provided and are now being analyzed, both by the FDA and by the distributor, and results are expected within days. At this time there is little more information, but there has been much confusion and rumor. According to early press reports, previous tests had found too little or too much ddC in some capsules. AIDS TREATMENT NEWS has asked the FDA for lot numbers of any samples found to be defective. So far, however, no such information is available. The following excerpt from a January 29 press statement from Project Inform, which has worked with the buyers' clubs in this situation, provides background information and perspective: "It is clear that no firm information has been presented by any source in this matter. Since apparently anonymous accusations have been made, however, it is appropriate that the FDA examine samples of the product. Buyers' club personnel and community activists welcome this inspection. "ddC supplied to the buyers' club is quality-controlled by its manufacturer, as are all products sold by pharmacies. Neither buyers' clubs nor retail pharmacies routinely perform independent quality assurance testing. The manufacturer of the buyers' club ddC does routinely supply analyses of random samples of the product shipped to the clubs. This analysis is performed by a reputable, independent laboratory and the results are supplied both to the clubs and sometimes to community organizations like Project Inform. These analyses, which include measuring the dosage of individual pills, have not identified any problem in the past, although some degree of variance from the labeled dosing is likely -- as it is even with Hoffmann-La Roche supplied ddC. This does not mean that problems are impossible, however, since even major pharmaceutical companies sometimes experience problems of this nature. "To date, Project Inform has received no significant reports of toxicity from buyers' club ddC, other than the toxicities which are likewise associated with Hoffmann-La Roche ddC. At this time, we believe that serious concern over the product seems unwarranted. Out of concern for patient safety some buyers' clubs, but not all, have temporarily suspended sale of the ddC pending analysis by FDA and independent sampling. "Those patients seeking the advice of Project Inform will be told that they may choose to continue use of the product in hand unless they are experiencing evidence of the side effects known to be common to ddC, such as peripheral neuropathy. In the event of such problems, patients should stop using the drug, whether it comes from a buyers' club or from Hoffmann-La Roche. Project Inform further hopes that this incident, whatever its cause, does not cause undue panic or anxiety among patients. Although a dose ranging from 50 percent below to 300 percent above that recommended might be problematic, it is instructive to remember that early clinical trials of ddC by the government used a dose several hundred times higher than that now employed. Although this produced significant side effects, in no case was it known to endanger a patient's life." [Note: the figure of doses 50 percent too low to 300 percent too high has appeared in some newspaper reports on this matter, but has never been verified.] ***** AZT: European Study Stopped, Disease Progression Reduced by John S. James A major European/Australian study comparing AZT to placebo in almost one thousand patients was halted recently after a preliminary analysis showed that those receiving the drug were less than half as likely to progress to illness or low T-helper count as those receiving the placebo. In what may be the most significant result of this study, AZT was found to work at least as well for asymptomatics who had high T-helper counts (500-750) when they began the study, as for those with lower T- helper counts. Of those who entered the study with counts between 500 and 750, 18% of those assig\J& to placebo progressed to an "endpoint" (either HIV-related illness, or T- helper count below 350), vs. 9% of those randomly assigned to AZT. Of those with T-helper count between 400 and 500 at entry, 38% of those given placebo progressed, compared to 20% of those given AZT. [Note: this data, first analyzed by a Data Safety Monitoring Board, was provided in a February 3 press release by Burroughs-Wellcome.] The dose used, 500 mg twice daily, was twice the standard U. S. dose; the dose was reduced to 250 every 12 hours (equivalent to the U. S. dose) if side effects developed. With this regimen, there was no difference in severe side effects reported between AZT and placebo, in these relatively healthy patients. [Note: There is no reason to believe that the large dose used in this study was necessary. Major U. S. studies have found no additional benefit from using over 500 mg per day. The only reason for the large dose is that this trial started in December 1988, when higher doses were in general use.] Note that this study is not the well-known "Concorde" AZT study, which is still ongoing in Europe. The two studies are in different patient groups. In the Concorde study, about two thirds of the participants had T-helper counts less than 500 at entry; in the study reported here, about three fourths had T- helper counts more than 500. Comment This study will probably support the growing belief among some AIDS experts that antiviral treatment should begin as early as possible -- as soon as one knows one is HIV positive -- regardless of T-helper count. ***** International AIDS Conference: Abstracts Due March 2; "Alternative" Abstracts Sought The VIII International Conference on AIDS, the main scientific meeting in 1992, was originally scheduled for Boston but moved to Amsterdam because of uncertainty about whether delegates with HIV would have difficulty entering the United States to attend (for background, see AIDS TREATMENT NEWS #128, June 7, 1991). The Conference organizers have published a new call for abstracts and registration. March 2 is the deadline for receipt in Amsterdam of: * All abstracts submitted to the Conference; * Applications for all scholarships and sponsorships; and * Registration at the advance registration fee. This year's International Conference, which together with the III STD World Congress will be held July 19-24 at the RAI International Exhibition and Conference Center in Amsterdam, is more international than any previous one, with more diversity in the Program Committee and the International Steering Committee than before. Other innovations include: * Special sessions for important research which happened after the abstract submission deadline -- to provide more current information; * Organization of the entire program around a list of critical questions and issues, developed by experts from around the world -- which should provide a more practical focus than at previous conferences, resulting in more practical information for use afterwards; * More time at presentations for discussion and analysis; and * Publishing mailing addresses, phone numbers, and fax numbers of presenters with each abstract, to facilitate communication and collaboration later. The Conference sponsors are Harvard University and the Dutch Foundation -- AIDS Conference 1992; co-sponsors are the International AIDS Society and the World Health Organization. The main program breakdown into four tracks is parallel to previous years: Basic Science; Clinical Science and Care; Epidemiology; and Social Impact and Response. The theme of this year's conference is A World United Against AIDS. A number of satellite meetings, not officially Conference events but encouraged by the Conference, will be sponsored by other groups such as professional organizations, other nonprofit and non-governmental organizations, and pharmaceutical companies, both before and after the Conference itself. For full information, including instructions and forms for submitting an abstract, registration and hotel information, commercial and nonprofit exhibit space, or how to apply for a scholarship, obtain a copy of the New Call for Abstracts and Registration. It is available from the Harvard AIDS Institute, 8 Story Street, Cambridge, Massachusetts 02138; fax 617/495-2863; phone 617/495-0478. [Note on "alternative" therapies: This Conference seems more open than most of the previous ones to abstracts on alternative, traditional, or indigenous therapies and healing systems. It also provides a second abstract format for information resulting from practical experience rather than from formal academic research. To reach the coalition working for the inclusion of such information in this Conference, contact The Center for Natural and Traditional Medicines (CNTM), P. O. Box 21735, Washington, D. C., 90009; fax 202/332-2132; phone 202/345-9632. Note: for other Conference information, call the Harvard AIDS Institute at the numbers above.] ***** Clinical Trials Design Conference, March 5-6, San Francisco The Second Regional Symposium on the Design and Methods of Clinical Trials, organized by the Department of Epidemiology and Biostatistics and the Department of Medicine of the University of California San Francisco, will take place at Carr Auditorium at San Francisco General Hospital on March 5 and 6, 1992. Topics include: experimental vs. observational studies; sample size; stratification, blinding, and bias control; protection of human subjects; interacting with the FDA; and publishing results. Registration is $100 general, $50 UCSF faculty, or $25 students, residents, interns, and fellows. For registration information, call 415/476-5808. ***** Correction: Chicago Buyers' Club Phone Number The AIDS TREATMENT NEWS resource list of phone numbers for ACT UP affiliates, buyers' clubs, and PWA coalitions, included an erroneous number for the buyers' club in Chicago. The correct listing is Options for AIDS Treatments, 312/784-2349. ***** AIDS TREATMENT NEWS Staff Changes Two of the key people at AIDS TREATMENT NEWS are leaving this organization to begin other AIDS work. Denny Smith, who has been with AIDS TREATMENT NEWS for over four years, is moving to St. Mary's Hospital in San Francisco, where he will be their HIV trials specialist, keeping the hospital staff and patients informed about trials that are available. Denny will continue to write occasionally for AIDS TREATMENT NEWS, and will remain on our masthead. Keith Griffith, who has been with AIDS TREATMENT NEWS for almost two years and created our first marketing program, will be leaving in mid February. He will join the staff of American Preferred Plan (APP), a mail-order pharmacy which specializes in drugs for AIDS, cancer, and other chronic illnesses. Keith will open a San Francisco office for the company, which is based in Farmingdale, New York. ***** AIDS TREATMENT NEWS Published twice monthly Subscription and Editorial Office: P. O. Box 411256 San Francisco, CA 94141 800/TREAT-1-2 toll-free U. S. and Canada 415/255-0588 regular office number 415/255-4659 fax Editor and Publisher: John S. James Medical Reporters: John S. James Michelle Roland Denny Smith Reader Services, Business, and Marketing: Thom Fontaine Keith Griffith Laura Thomas Tadd Tobias Rae Trewartha Statement of Purpose: AIDS TREATMENT NEWS reports on experimental and standard treatments, especially those available now. We interview physicians, scientists, other health professionals, and persons with AIDS or HIV; we also collect information from meetings and conferences, medical journals, and computer databases. 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. Subscription Information: Call 800/TREAT-1-2 Businesses, Institutions, Professionals: $230/year. Nonprofit organizations: $115/year. Individuals: $100/year, or $60 for six months. Special discount for persons with financial difficulties: $45/year, or $24 for six months. If you cannot afford a subscription, please write or call. Outside North, Central, or South America, add air mail postage: $20/year, $10 for six months. Back issues available. Fax subscriptions, bulk rates, and multiple subscriptions are available; contact our office for details. Please send U. S. funds: personal check or bank draft, international postal money order, or travelers checks. VISA, Mastercard, and purchase orders also accepted. ISSN # 1052-4207 Copyright 1992 by John S. James. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&