AIDS TREATMENT NEWS Issue #177, June 18, 1993 phone 800/TREAT-1-2, or 415/861-2432 CONTENTS: Berlin Conference Overview Berlin: Concorde Trial Questions Early AZT Use -- Wider Implications Proposal: A Better Strategy for Developing AIDS Drugs HIV Immigration Ban, Travel Restrictions P Current Status Announcements AIDS, Medicine & Miracles: Two Regional Conferences, Berkeley, July 8-11, and New York, Sept. 23-26 AIDS Basic Research: TAG Releases In-Depth Report on Scientific Directions, also Funding and Management Problems Curcumin: San Francisco Buyers' Club Survey ***** Berlin Conference Overview by John S. James [Note: Much of our Berlin coverage was not ready for this issue, and will appear later.] For the last nine years, the International Conference on AIDS has been the major scientific meeting of the year. The 1993 conference, June 6-11 in Berlin, was like the others in several ways: * About 12,000 persons attended, about as many as in recent years. * No one expected a major breakthrough, and none was announced. (This is not surprising, since it would be wrong to delay announcing an important advance in order to wait for a conference.) * A number of potentially important advances in understanding AIDS came to light; significant progress was reported. But most of them were not immediately relevant to better patient care. * Overall, people left the meeting with the usual annual disappointment at how little has been accomplished in finding better treatments for AIDS -- and with worse reports each year about the rapid spread of HIV in populations around the world, and the inadequacy of the efforts to stop it. But the Berlin conference also differed from previous meetings in several ways: * Better quality research is now being reported. This improvement reflects better design of clinical trials during the last two to three years (compared to those designed earlier), as well as the availability of better virological tests. The results of the new trials are now coming in. But many of these results were negative or inconclusive. The basic reason is that while the technique of trials has improved, the vision of what is needed, and the selection of drugs to study, has not. Major clinical trials, even when publicly funded, are still driven by commercial pressures in a game of influence that only large companies can play, generally assuring copycat products attempting to imitate the big commercial success (AZT) of the past. * The situation for physicians and patients making treatment decisions is more confusing after this conference than before. Most people seem to be responding by continuing what they would have been doing anyway, until enough clarity and consensus develop to support new decisions. This differs from most previous conferences, where there was less potential impact on treatment because less accomplishment was reported. * Another improvement this year is that the top leadership of AIDS research is more open to new ideas than before -- both the same ideas dismissed in the past, and new observations which might or might not turn out to be critically important. * While figures are not available, reports suggest that there was less media coverage of this conference than in previous years. But working journalists were as busy as ever in the media facilities provided. The fewer column inches this year could indicate more seriousness rather than less interest, since during the last two years, much of the coverage resulted from media feeding frenzies: two years ago, an unfortunate remark about a "deep kiss" possibly spreading AIDS; and last year, ICL (idiopathic CD4+ T lymphocytopenia, meaning AIDS-like immune deficiency with no finding of HIV or any other known cause), which got media attention because of the possibility that it could affect people who considered themselves removed from AIDS. The talk in the press room last year was that the reporters already knew that ICL was a non- story (probably reflecting only the fact that more immunological testing was being done), but were running with it anyway because everyone else was. This year produced no comparable false headlines. What Wasn't in Berlin Our deepest impression from the conference is that the most important and productive approach possible to saving the lives of those already infected was simply not on the table there -- not among the scientists, not among the physicians, and not among the activists. The greatest need, everyone did seem to agree, is for better drugs -- including drugs which control HIV activity in chronically as well as acutely infected cells. Existing drugs are largely useless in chronically infected cells, which maintain reservoirs of virus to provide a source of endless mutations to escape control by the drugs we have and also by the immune system itself. But there are many potential treatments which do control HIV in chronically infected cells in laboratory tests, and are probably safe to use, and could be inexpensive and readily available. If they can greatly suppress HIV activity in humans (which is fairly easy to test), then they will probably be major advances in AIDS/HIV treatment. The last issue of AIDS TREATMENT NEWS included a background report on one such possibility, curcumin, which is already in the human diet because it is contained in curry. Our conference coverage will include at least two others -- a protease inhibitor which received much attention at the conference (although it is limited by major supply problems), and an LTR inhibitor, topotecan, which is now in human trials for cancer. Probably dozens of such candidate treatments, many already in human use so that basic safety information is available, could be identified from the published literature alone. It would take a few weeks and probably less than $50,000 each to test them for antiviral activity in humans. While the odds are against each possibility individually, cumulatively it is very likely that such a program would produce at least one major treatment advance, entirely changing the current picture of HIV care. If the treatment was already known to be safe, it could be in widespread use within months. The reason this hasn't been done already is because nobody is pushing for it. Not pharmaceutical companies, which are only interested in drugs when they have the patent rights, the marketing prospects, the executive commitment, and the personnel, capitol, facilities (manufacturing, laboratory, etc.) and all other resources available. Not government programs, where good ideas must wait in line along with bad ones, and where funding reductions are likely to affect both equally. Not private charity, which usually won't touch AIDS -- and when it will, usually won't touch research. Not community-based research, which was intended to address this gap, but in practice seldom has the funding to be independent, and must limit itself to funded projects, almost always drugs which pharmaceutical companies are already developing anyway. And not established researchers, unlikely to be attracted to something simple that would highlight a decade's failure to produce practical HIV treatment advances. The "alternative" and "underground" treatment movements come closest to addressing this opportunity (curcumin is already being tested this way), but they have not had the resources to do formal trials. The clear impression at Berlin was that the whole world is accepting the lack of progress in AIDS treatments as inevitable, and overlooking the fact that the entire situation could be turned around in a rapid, straightforward and relatively inexpensive way, if there were the institutional will to do so. We will continue to develop this possibility below, and in future issues. ***** Berlin: Concorde Trial Questions Early AZT Use -- Wider Implications by John S. James The Concorde trial may be the most influential single presentation at the Berlin conference -- but not because of its data, analysis, or contribution to care. Instead, Concorde is important for prompting rethinking about AIDS, both for better and for worse. Background On April 2, 1993, the medical journal The Lancet published a one-page letter reporting preliminary analysis of the largest clinical trial of early treatment with AZT -- the Concorde trial, conducted in the UK, France, and Ireland. This analysis questioned the benefit of early use of AZT (in persons who are asymptomatic and who have no other reason which would prompt the physician and patient to decide to begin treatment). In these patients, the study found no long- term benefit of starting AZT immediately, vs. waiting and starting later. There was a small short-term benefit of immediate treatment in delaying disease progression. But after three years, the two groups were doing about equally well. Because AZT did raise T-helper counts, but did not show long- term benefit in this group of patients, the Concorde researchers suggested that T-helper counts may not be a suitable measure for testing new drugs, and that "clinical endpoints" (death or major disease progression) may need to be used instead. (Because HIV disease develops slowly, a policy of requiring clinical endpoints is likely to add several years development time to each new AIDS drug or drug combination tested, resulting in the de facto abandonment of early treatment, and in major delays for all new AIDS drugs.) After the Lancet letter, U.S. researchers were angry that they were asked to accept such sweeping conclusions on the basis of so little information. They could not bring their professional judgment to bear because data was not available to them. That was the context in which we published our critique of the Concorde analysis ("AZT, Early Intervention, and the Concorde Controversy," AIDS TREATMENT NEWS #173, April 23, 1993). We argued that the Concorde results might be explainable within the conventional framework (AZT works in early disease, T-helper count works as a marker of drug efficacy), if the physicians started treatment strategically in the "deferred" treatment group, with the rapid T-helper boost from AZT heading off clinical endpoints, or at least postponing them until after the December 31, 1992 data cut- off for the analysis. At the Berlin conference, much more Concorde information was released, especially in the June 8 talk by M. Seligmann (tape #27; see information below on ordering audio tapes), and by the trial's statistician, A. Babiker, on June 10, who is not listed in the program because he replaced Seligmann on that day (tape #96). Nothing we have heard so far makes us believe that our critique was erroneous. But it may not be relevant today, because other issues are now on the table. Before going on to these, we want to state one concern behind our critique which should still be kept in mind. The Concorde trial, after its protocol modification of October 1989 to allow voluntary switches to AZT for persons with T-helper counts under 500, did include medical judgment as an integral part of the "deferred treatment" strategy being tested. And the Concorde physicians seem to have provided excellent medical care, with both groups of patients doing unexpectedly well. But a strategy which worked in the hands of expert physicians, providing careful monitoring as part of a major trial, might not be as good in other settings where it has not been tested, such as in the offices of inexperienced physicians, or in rushed public clinics. This should be considered before the strategy is transferred wholesale to such settings. Despite this concern, the bottom line from Concorde still seems to be that if early treatment with AZT did work, it didn't work very well; otherwise we would have seen more evidence of benefit in the results. The question now is where do we go from here. Uses of Concorde If Concorde is accepted unthinkingly, it throws away not only the early treatment we have, but the chance of getting others in the foreseeable future. That is because statistical proof using clinical endpoints in early HIV disease requires long, large trials. Adding the time required to conduct and analyze the trial itself, the time for recruiting, and the time to build the required commercial and professional momentum to get a large trial going, it is likely to take several years to test each drug or combination. Such trials are not feasible for many reasons. They would compete with each other for patients and resources, for example; and when they were done, the drugs and treatment philosophies they started to test would likely be obsolete. The pressure, therefore, is to abandon treatment, writing off people with HIV, and shift the focus to controlling the disease only through prevention. This is how mainstream newspaper editorials are interpreting the Berlin conference results (and especially the Concorde results). For example, a June 17 editorial in The New York Times cites the Concorde results (by saying that AZT "apparently has little or no effect when given to people who are infected with the virus but have not yet developed symptoms"); the opening paragraph concludes that, "There is little choice now but to shift the emphasis to prevention programs." We will refer to this editorial again, because buried in it is a more positive statement which supports another major use of the Concorde results. And worldwide AIDS prevention is indeed so critically important today that nothing must be allowed to detract from it. But the Times editorial and others like it do illustrate the danger that Concorde will be used to save money (especially for government agencies like national health services) by abandoning treatment for people with HIV. Despite this danger, U.S. AIDS activists are often welcoming the Concorde report. They are using it for a different purpose -- as a focus for a repudiation of third-rate drugs (AZT, etc.) which have been tested interminably because they pay the bills, even though it is clear that they are inherently limited and will never work very well. Meanwhile, possibilities for more important advances have been neglected -- the result of sloppy commercialization of science, and of lack of planning in the public interest. There have long been movements against AZT. Most of those in the past have told people not to use it, to reject their doctor's advice if necessary. Often they have told people to use something else instead, often something with little reliable data about its usefulness in HIV, yet still proposed as the one blanket answer for almost everyone. AIDS TREATMENT NEWS has seldom covered these movements, because we have been unwilling to tell people to discard their doctor's advice. What might be coming out of Concorde is a different kind of rejection of AZT. It recognizes that this drug has a legitimate and important place in HIV treatment today, that it is better than nothing for many people, and that since there is no single answer for everyone, the decisions about whether, when, and how to use it should be made individually, by consultation between patients and their physicians. But at the same time, it calls for a redirecting of AIDS trials away from their current focus on third-rate drugs. The New York Times editorial quoted above also included the sentence, "Current drugs are a dead end; researchers need radically new approaches in the search for cures and vaccines." ***** Proposal: A Better Strategy for Developing AIDS Drugs by John S. James It is widely agreed that what is most needed for better AIDS treatment is better drugs -- and that the drug-development strategies of the past have failed to provide them. If the Concorde report at the Berlin conference does lead to a movement among activists and others against AZT and the other third-rate AIDS drugs now available, then the success and value of this movement will centrally depend on the quality of the alternative drug-development strategies which it can advocate. It is not enough to only say what has been wrong so far; we also need to suggest ways to fix it. To contribute toward this thinking, we have outlined what we believe would be the most important advance today in conducting clinical trials and moving the results into clinical practice. Details remain to be filled in, and changes to the overall picture will be required. But this effort needs the work of many people, so we decided to present what we can suggest now, instead of waiting to develop it as a more finished proposal. Antivirals -- and Viral Activity Tests Two major directions now for drug development are (1) improved antivirals, especially practical treatments which suppress HIV in chronically as well as acutely infected cells, and (2) immune-system treatments, both to control the virus indirectly, and to repair damage already done. Our choice is to start with antivirals, because today they are easier to test. It is much easier to tell if an antiviral is doing what you want it to do, than to tell if an immune therapy is doing something that will help in the long run. Screening drugs to test for antiviral activity in humans has long been a minor part of conventional drug development -- even several years ago, when only the crude p24 antigen test was available for this purpose. AZT, ddI, etc. do pass the antiviral activity test. What has been done is to select a few volunteers who have a p24 antigen value high enough to read on the tests then available, have them start using the proposed antiviral, and watch their p24 antigen levels for a few weeks to see if they are reduced. The strategy we propose would: (1) Make this kind of test for antiviral activity in humans central to HIV drug development, not peripheral to it. (2) Take advantage of the advances in viral testing which are about to become available, such as sensitive tests for HIV RNA, which are not commercially available but can be used by researchers through special arrangements. Meanwhile, testing could also be done with the newer p24 antigen test (called "acid dissociated" or "ICD" p24) which is already in common use in medical practice, at least in most states (it has been difficult to obtain in New York, due to the way medical laboratories are regulated there). (3) Use these small, fast antiviral activity trials to test many kinds of antivirals, not only nucleoside analogs or other reverse transcriptase inhibitors. The same kind of trial will work for drugs which act at different parts of the viral life cycle -- and even for certain immune-based therapies or nutritional interventions, if they might reduce viral activity indirectly. It is especially important to test drugs which have shown activity against HIV in laboratory tests with chronically infected cells, where reverse- transcriptase inhibitors are not effective. (4) When a drug is known to be safe, and known to show antiviral activity in humans, then it should be made available as an option to physicians and patients, without waiting for a large phase III trial to get definitive proof of clinical benefit. In testing treatments for an infectious disease, control of the causative organism is not a "surrogate marker" which must itself be validated by years'- long clinical trials before it can be used. It is, instead, the central goal of therapy. (5) Rapidly develop the improved viral-activity tests which already exist in research laboratories, to make them available to practicing physicians, who can then use them to individualize their patients' therapies. Physicians would continuously monitor the test results, and whenever they found viral activity, try the various drugs developed as above (drugs known to suppress viral activity in humans), until they find a drug, dose, or combination which suppresses it. Then they would keep monitoring, and change the treatment regimen again if viral activity ever came back. (6) With sensitive enough viral activity tests, this strategy could be applied to early HIV treatment also, for example when T-helper counts are over 500. It might or might not be necessary to treat everybody. But it will be necessary to monitor everybody, to start treatment as soon as each patient need it. Advantages The conventional approach to testing AIDS drugs is illustrated by the Concorde trial. A drug or combination is selected for testing, and then it is applied in a standard way, with as little individual variation as possible, to randomly selected members of a group of patients. Others are randomly selected for one or more comparison treatments. The message from Concorde is that these trials must run for several years, and must look for differences in survival or major disease progression, as short-term results or T-helper count changes are not reliable. After an immense effort requiring hundreds of volunteers and lasting for years, a single drug or one particular combination is either accepted or rejected. The alternative strategy proposed above tests new drugs and combinations in weeks, not in years. Then, once safety can also be assured, the new treatment could be made widely available as an option to physicians. Once a drug is known to be safe and known to have good antiviral activity in humans, physicians should be allowed to weigh its advantages and disadvantages, in comparison with those of other available treatments, and use their medical judgment. Another advantage of the proposed strategy is that it produces individualized treatments, giving a range of options which can be tested and refined for each patient. Conventional HIV drug development, based on statistical averages, tests a single treatment on everyone. It is now widely accepted that much of the progression of HIV disease is caused by worse viruses (drug-resistant viruses, syncytia-inducing viruses, etc.), which arise from mutations as HIV reproduces. Drugs like AZT block only the reverse transcriptase step in the HIV life cycle; in chronically infected cells, where this step has already taken place, the virus remains active. Partially blocking the virus, as the current drugs do, creates ideal conditions for drug-resistant and other mutants to evolve. What needs to be done is to block viral activity as much as possible, so that there will be very little reproduction and little chance for harmful mutants to be produced. To do this, we need different kinds of drugs, better viral tests to make sure the drugs are working in a particular patient, and a greater number and diversity of treatment options, so that when one treatment fails it can be replaced. What can be done to put this kind of strategy into practice? The first step is to talk about it, and refine the idea. As wider consensus develops, trials will be designed and conducted, one by one. This doesn't need to wait for any central decision. ***** HIV Immigration Ban, Travel Restrictions P Current Status by John S. James The HIV immigration ban recently passed by Congress and attached to the NIH Reauthorization Act was signed into law by President Clinton on June 10. Clinton opposed the HIV restriction initially, but did not speak actively against it in Congress. Since Clinton could not veto the bill without also vetoing the NIH Reauthorization Act, which included important reforms for AIDS, cancer, women's health, and other medical research, the AIDS community did not push for a veto. The news came while we were in Berlin covering the International Conference on AIDS. When one German told us he was dropping out of an international research study because he feared that U.S. authorities might get his name and he would never be able to visit his friends in the United States again, we said that was unnecessary to drop out because there were waiver provisions for short-term visits of up to 30 days, long enough for scientific conferences and for most personal and business visits; if his future plans did not call for any longer stay, they would not be disrupted. The possibility of waivers had not been reported in the German press account -- and probably not elsewhere in the world's press either. We decided to publish this information in an effort to reduce damage to AIDS research and prevention programs worldwide. After returning from Berlin we researched the situation further, and talked to Aimee Berenson, legislative counsel for the AIDS Action Council in Washington, D.C. We learned that the new law does not change the existing policy which allows such waivers, but that there is much uncertainty about how the Attorney General will use her discretion to continue these waivers, so no one knows what will be available in practice in the future. The new HIV ban consists of less than one sentence. The previous law, the Immigration and Nationality Act of 1990, listed as excludable "any alien who is determined (in accordance with regulations prescribed by the Secretary of Health and Human Services) to have a communicable disease of public health significance." The new legislation adds, "which shall include infection with the etiologic agent for acquired immune deficiency syndrome." This does not change the U.S. policy which existed before the law was passed, but freezes it so that it cannot be changed administratively. The legislation overrules the U.S. Public Health Service, which for years has wanted to list only active tuberculosis as an excludable condition under this section, but was blocked from removing HIV by the Bush administration. Now HIV must be listed by an act of Congress, no matter what public-health officials determine or what the president decides. Under current practice, customs officials do not seek out short-term visitors who have HIV. If visitors arrive here and then declare that they have HIV, or if AZT or other AIDS drugs are found in their luggage, they are questioned about the purpose of their trip and whether they have health insurance. Then they may be given a waiver and released to continue their trip. We do not know how many waivers are denied since statistics are not available; also we do not know how many visitors are excluded without an official denial by being forced to choose between returning immediately or waiting in detention, sometimes for weeks, before their case will be heard. AIDS activists have only heard of a few cases, but probably never hear about most of the people who are barred and sent back. [For applicants for permanent residence -- usually long-term U.S. residents now trying to legalize their status -- waivers are much more restrictive. They may be allowed only for specified family members: "the spouse or the unmarried son or daughter, or the minor unmarried lawfully adopted child, of a United States citizen, or of an alien lawfully admitted for permanent residence, or of an alien who has been issued an immigrant visa," or for an applicant who "has a son or daughter who is a United States citizen, or an alien lawfully admitted for permanent residence, or an alien who has been issued an immigrant visa." Many cases do not fit this definition, and families are sometimes broken up. The new law guarantees that this situation will continue.] For short-term visitors, Attorney General Janet Reno could revise the regulations -- such as making waivers automatic for trips of up to 30 days, so that short-term visitors do not need to worry about bringing their medicines with them, and could make their travel plans and business plans without this uncertainty. But there are also proposals to make the restrictions more burdensome, such as requiring a large money bond to prevent people from overstaying their visas. It is not known if the Attorney General will address these regulations at all -- and if she does, whether the result will be better or worse than the current situation. In short, there is a good chance that persons with HIV will be able to come to the United States for short trips to visit family or friends, attend scientific conferences, conduct business, travel as tourists, or purchase medical care not otherwise available. But no assurances can be given. The Guantnamo Camp On June 8, a Federal judge ruled that the U.S. must release the 158 HIV-positive Haitian refugees held for 18 months at the U.S. naval base in Guantnamo, Cuba. U.S. authorities had determined that they had a legitimate fear of persecution if returned to Haiti. But then when they tested HIV-positive, the U.S. refused to process their applications for political asylum, because of the U.S. policy of excluding persons with HIV -- the same policy which Clinton said he wanted to change, but which the new law makes permanent. The Clinton administration decided not to immediately appeal (thanks in part to major public protests against the mistreatment of the Haitians), and by June 14 the barbed wire at the camp had come down, and some of the Haitians had already been flown to the U.S. Some people have erroneously believed that this decision overruled the HIV ban. But, as Ms. Berenson explained, the judge only ruled that if the United States detains people, then it must provide them with due process (the chance to pursue their legal case for political asylum) and with medical care -- and that their HIV status cannot be a basis for denying them their basic rights. He did not rule on the constitutionality of the ban itself. Comment By sending a high-profile message around the world that people known to have HIV cannot count on fair treatment, Congress has created an incentive for everyone in the world to not be tested for HIV -- and for those who already know they are positive to avoid the public-health system, avoid volunteering for medical research, and avoid working with AIDS-control efforts. AIDS prevention efforts around the world are centrally based on trust that people can step forward and cooperate with public-health programs, without suffering unbearable consequences as a result. No amount of compulsion or regimentation will replace what this trust can do. Damaging trust makes AIDS prevention everywhere work less well. The ostensible purpose of the new law was to save money by excluding from the U.S. people who might need medical care at public expense. The real purpose was to harm the Clinton presidency so that Republicans will have a better chance of winning the White House back in 1996. Democrats were slow to support Clinton because some of their leaders in the Senate think that they themselves were more worthy than he was to be president. The ban also reflects hostility against immigrants (increasing around the world due to economic problems, especially the growth of a high-tech global economy which no longer has room for much of the middle class), and hatred of gays, also increased due to economic problems. The religious right, obsessed with homosexuality, still sees AIDS as a gay disease; according to one estimate, it generated several hundred thousand calls to Congress supporting the ban, compared to less than a tenth as many opposed. Having finished its game of political football, Congress can simply walk away. But the world will pay with money and with lives for a long time to come. Notes: 1. For a review of some of the history of the conflict over the U.S. HIV immigration ban, see AIDS TREATMENT NEWS issue # 128, July 12, 1991; also see notices in several of the following issues, through September 6, 1991. 2. Another part of the story is that in the recent case, the AIDS community did a poor job of mobilizing immediate grassroots political support -- massive calls and letters from people to their Congressional representatives -- against the ban. It is widely believed, among AIDS political specialists outside the Beltway, that the basic problem is that some of our Washington organizers are not good at grassroots organizing because they are threatened by it, as their stock in trade is their inside connections. We are not close enough to judge the accuracy of this diagnosis. But we do know that until the AIDS community can both do the inside work and also organize at least 100,000 calls and letters to Congress within days on a major national issue, we will always be vulnerable to this kind of attack, unable to protect the vital needs of the nationwide and worldwide fight against the epidemic. And behind the calls and letters, we must have policies which are widely understood and supported by the public, and also by activists in many different causes. To those who say it can't be done, we point out that it was done, and on this very issue, in 1991, when 117,902 people wrote to the U.S. Centers for Disease Control during a public-comment period to oppose the same ban which Congress just now passed into law. 17,833 people supported the ban at that time. (These figures were provided by the CDC, and were published in AIDS TREATMENT NEWS issue #134, September 6, 1991.) To those who say we can't spare the energy, since it must go into other pressing matters of the epidemic, we point out that different people mobilize for different purposes; with effective leadership, many would come out to do political work who otherwise would not be volunteering for AIDS at all. Yet even without the 100,000 calls, Congress still bears institutional responsibility for its actions. To use a deadly epidemic as a political football, with no regard for the consequences, is a monstrous disservice. ***** Announcements ** AIDS, Medicine & Miracles: Two Regional Conferences, Berkeley July 8-11, and New York, Sept. 23-26 For the last five years, AIDS, Medicine & Miracles has held a well-regarded annual conference in Boulder, Colorado. This year the annual meeting has been replaced by two regional retreats, in Berkeley, California, on July 8-11, and in Rhinebeck, New York, on September 23-26. These meetings combine personal support with AIDS treatment information. The Berkeley meeting, at the Clark Kerr Campus of the University of California at Berkeley (not the main campus, but a few blocks Southeast on Warring Street), will include speakers as diverse as Ram Dass (the keynote speaker on Thursday evening; he is the author of Be Here Now, and Compassion in Action), Martin Delaney and Sally Fisher on "Therapies That Hold Promise," researcher Paul Volberding, M.D., on "Current Therapies in HIV Treatment," Charles Steinberg, M.D. and Richard Elion, M.D., on "Bringing It All Together; Holistic Strategies, HIV, and the Immune System," and others. In addition there are over two dozen workshops at the Berkeley retreat, including Psychoneuroimmunology; Staying Healthy with HIV/AIDS; Intimacy and Safe Sex; Side Effects in Treatment of HIV/AIDS; The Life of Children with HIV; Nutritional Interventions in HIV Disease; Chinese Medicine; AIDS Ministry: Renewal of the Spirit; Heart to Heart: Healing the Healers; Running for the Health of It; and Massage: The Caring Bond. There are also pre-conference institutes, which usually cost extra. But one, "Empowering Women with HIV/AIDS," is free. The New York program will have some of the same topics and speakers, but many will be different. Prices for the Berkeley meeting, including lodging and meals for the three days, are $370 (double room) to $405 (single); commuter registration is $290. Full and partial scholarships are available to persons with HIV disability and financial hardship; about 100 have already been given. Continuing education credit is available. For more information about either the West Coast or East Coast retreat, call AIDS, Medicine & Miracles, 800/875-8770 or 303/447-8777; their fax number is 303/447-3902. ** AIDS Basic Research: TAG Releases In-Depth Report on Scientific Directions, also Funding and Management Problems Basic Research on HIV Infection: A Report From the Front, a 34-page document prepared by Gregg Gonsalves and published by the New York-based Treatment Action Group (TAG), is based on interviews with over 50 scientists, mostly virologists and immunologists; it was released at the International Conference on AIDS in Berlin. TAG is the group which previously conducted a major review of AIDS research at U.S. National Institutes of Health, and based on that review, made reform proposals which were introduced into the NIH Reauthorization Act and recently became law. The new report includes unusually candid assessments of what is wrong in research and what should be done to improve it. Most of the researchers interviewed are named in the introduction; but to encourage candor, statements made were not attributed to specific people. Most of the report looks at the scientific issues -- what is most important to study now, and why. But equally important for activists is the funding crisis, with only about 10 percent of the applications to NIH now receiving funding, and most researchers needing to spend 30 to 40 percent of their time writing grants, to the detriment of their work. For a copy of the report, contact TAG at 212/260-0300, or 212/260-8561(fax), or by writing to 147 Second Avenue, #601, New York, NY 10003. ** Curcumin: San Francisco Buyers' Club Survey The Healing Alternatives Foundation has started a survey of people trying curcumin (described in our last issue, AIDS TREATMENT NEWS #176, June 4, 1993). The one-page survey only asks for dosage and dates of use, possible side effects, p24 antigen test values (if available), and contact information (optional). The purpose is to get a quick overview of peoples' experiences, and also to be able to follow up with a telephone interview later, if it turns out that additional information would be useful. For more information, call Healing Alternatives at 415/626- 4053. ***** 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: Jason Heyman John S. James Nancy Solomon Reader Services and Business: David Keith Thom Fontaine 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 1993 by John S. James. 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