Subject: AIDS Treatment News #104 Date: Jun 11 1990 (825 lines) &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& J O H N J A M E S writes on A I D S &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& copyright 1990 by John S. James; permission granted for non-commercial use. AIDS TREATMENT NEWS Issue # 104, June 1, 1990 CONTENTS: [items are separated by "*****" for this display] Hyperthermia Report: Only One Patient ddC: Expanded Access Announced for Patients Without Other Options Parallel Track Proposal Released: Public Comment Accepted Through June 20 Consensus Statement: AIDS Groups Seek Better Research Priorities Toxoplasmosis Update Compound Q: Continuing Good News Sixth International Conference News: ACT UP/ACT Now Calendar; Arts Event Sponsored by "69 Hours"; International Public Computer Links During Conference Announcements: Trials Combining AZT and ddI Now Recruiting; Start-Up Grants for Care or Support to People with AIDS ***** HYPERTHERMIA REPORT: ONLY ONE PATIENT by John S. James In the last week of May, CNN television and other media reported a single case of a patient with AIDS and Kaposi's sarcoma (KS), who seemed to be much improved after hyperthermia, a treatment which consists of artificially raising the body temperature. Hyperthermia was previously used for treating certain infections, such as syphilis, and is still used in some advanced cases of cancer. According to a brief written report by doctors Kenneth Alonso and William D. Logan Jr. of the Atlanta Heart and Lung Clinic at Atlanta Hospital, the patient had worsening KS and a T-helper count of 50 before beginning the treatment. AZT and alpha interferon had not prevented the symptoms from worsening. Institutional Review Board gave permission to try hyperthermia. Using tubes inserted in an artery and a vein in the thigh, blood was withdrawn, heated outside the body with a heat exchanger, and then put back into the circulation. With temperature carefully monitored by thermometers in the pulmonary artery and in the bladder, body temperature was gradually raised to 42 degrees C (between 107 and 108 degrees F) for two hours. The patient, who was under general anesthesia, was then cooled gradually. Lesions started to improve within 48 hours, and by seven days some were less than half of their original size. Maximum improvement had occurred at six weeks; some but not all of the lesions had disappeared. The patient's T-helper count had increased from 50 to 330. HIV cultures were negative (which may mean little, however, because of the unreliability of most viral cultures), and reverse transcriptase in the blood (a measure of viral activity) had fallen by 70 percent. The physicians submitted a report of this case for publication in a medical journal. When the story got into the press, they insisted that the treatment was not a cure. But some of the press reports suggested that despite the doctors' caution, the patient believed he was cured. Extensive coverage has led to hundreds of phone calls to the physicians and to AIDS service organizations. Comment It is hard to evaluate this report without detailed peer review. Most AIDS experts reached by reporters have been reluctant to say much on the record until they know more. Most do seem to agree that the treatment might be useful, and that it must be investigated further. Why would a report of a single case lead to national publicity? May is a "sweeps" month, when the audiences of TV stations are carefully measured in order to set advertising rates, and when, therefore, the stations do everything possible to boost their audiences. One media expert speculated that if the report had arrived a few days later, in June, it would not have been a story. It is unfortunate when widespread reporting raises hopes prematurely. But in this case the publicity may also have made an important contribution. Despite the widespread agreement that the treatment might be useful and should be investigated, there is a serious risk that no followup trial will be organized. Hyperthermia has little commercial potential, since it generates only one sale of a relatively simple and inexpensive machine to each center which uses it; it does not lead to repeat sales, as pharmaceuticals do. Hyperthermia has no constituency in the government or in any part of the AIDS research establishment. Hopefully the widespread publicity will generate enough interest so that someone will follow up with a small trial. Hyperthermia is dangerous if done improperly; it must be performed by knowledgeable physicians. Published articles on this technique describe extensive precautions which are taken for the patient's safety. If formal studies are not conducted, the treatment may instead come into use in the offices or clinics of physicians not trained to employ it properly. Fortunately, the procedure tried in one case with AIDS is exactly the same as that often used in treating cancer, meaning that the technology, staff training, precautions, risk estimates, etc. are already in place. As far as we know, the patient in Atlanta is the only person with AIDS who has been treated with hyperthermia. The idea had previously been suggested; see References, below. For More Information For more information, physicians can write to Dr. Kenneth Alonso, 203-B Medical Way, Riverdale, GA 30274, phone 404/991- 1971. Note: In a completely separate effort, Dr. Shawn Hankins, a chiropractor in Port Angeles, Washington, has been urging a test of hyperthermia since July, 1987. He points out that HIV is heat sensitive, and in addition, hyperthermia can cause increased T- cell proliferation, phagocytosis, and increased production of antibodies and interferon. Anecdotal observation, such as the "honeymoon effect" that sometimes follows pneumocystis (which causes a high fever) also supports this possibility. Dr. Hankins can be reached at 616 E. Front St., Port Angeles, WA 98362. References Brenner, S. HIV appears to have some susceptibility to heat [letter]. AIDS Research and Human Retroviruses, volume 5 number 1, pages 5-6, February 1989. Bull, JM. A review of systemic hyperthermia. Front. Radiat. Ther. Onc., volume 18, pages 171-176, 1984. Weatherburn, H. Hyperthermia and AIDS treatment [letter]. The British Journal of Radiology, volume 61 number 729, pages 863- 864, September 1988. Yatvin, Milton B. An approach to AIDS therapy using hyperthermia and membrane modification. Medical Hypotheses, volume 27, pages 163-165, 1988. News Flash Alonso to speak: Dr. Alonso is scheduled to speak about the hyperthermia treatment at the "alternative" AIDS conference in San Francisco, the Advanced Immune Discoveries Symposium, on Friday, June 22. For more information about this meeting, call the Foundation for Research of Natural Therapies, Foster City, CA 415/349-0718 (fax 415/349-1257). ***** DDC: EXPANDED ACCESS ANNOUNCED FOR PATIENTS WITHOUT OTHER OPTIONS by John S. James On June 25 Hoffmann-LaRoche will begin an expanded access program to provide ddC (proprietary name HIVID) to patients who have failed or been intolerant to AZT and are intolerant to ddI. This program will proceed in parallel with the formal clinical trials of the drug (for more information about the trials, see the last issue of AIDS TREATMENT NEWS, May 18, 1990). Those eligible for the new program could not participate in the trials, since they must be unable to use AZT in order to qualify for the expanded access; those in the formal trials of ddI must be able to use AZT, since they might be randomly assigned to it. Because ddC has never been tested on this patient population, the new program will begin gradually. At first only 50 people will be accepted and only from physicians who have prior experience with ddC. After 25 of them have been monitored for at least four weeks without serious problems, the program will be expanded to 200 people, and any physician with AIDS experience will be allowed to enter patients. After 100 people have been followed for 16 weeks without unexpected problems, there will be no numerical limit to how many may enter the program, if they meet the medical qualifications. All patients will be randomized to one of two doses; the highest dose will be the same as that used in the formal trials. Random assignment of doses greatly increases the useful information a trial can provide, because it allows scientists to look for a dose- response relationship in both toxicity and efficacy. (In this program the main reason for varying the dose is to collect safety information for these patients.) To be eligible for this program, patients must: * Either be unable to tolerate AZT (under the criteria used in the ddI expanded-access program), or meet other criteria indicating that AZT was ineffective for them; * Also be unable to tolerate ddI, for reasons other than peripheral neuropathy (which is a toxicity of ddC as well as of ddI); * And also not have cancer (KS is OK, however, and so is basal cell carcinoma). Starting June 25, physicians can call 800/ddC-21-HIV, Monday through Friday 9 a.m. to 8 p.m. Eastern time, for more information about this program. ***** PARALLEL TRACK PROPOSAL RELEASED: PUBLIC COMMENT ACCEPTED THROUGH JULY 20 The long-awaited proposal for a formal "parallel track" for early access to certain experimental drugs in phase II clinical trials, for people not eligible for those trials, has been published in the Federal Register (May 21, pages 20656-20659). The public- comment period ends July 20, and it is important to write to the address below to support this program. How is the official "parallel track" different from the expanded- access program for ddI (and now for ddC also see article in this issue of AIDS TREATMENT NEWS)? The ddI program is like the parallel track, but it was started separately to avoid being delayed until the formal program could begin. The AIDS Research Advisory Committee (ARAC) The parallel track proposal provides an official structure for deciding which drugs to recommend for early-access release. A major part of this structure, the AIDS Research Advisory Committee (ARAC), is "composed of outside scientists and physicians experienced with AIDS, persons with HIV-related diseases, and others." It will be administered by the U. S. National Institute for Allergy and Infectious Diseases (NIAID). The ARAC is only advisory; the FDA makes the final decision of whether a drug will be released. And of course the pharmaceutical-company sponsor must be willing and able to make the drug available. The parallel-track proposal allows sponsors to bypass the ARAC if they want, and submit their proposals directly to the FDA instead. (We consider this option a good idea, simply because nobody knows for sure how the ARAC will work in practice. Pharmaceutical companies will usually choose to go through the ARAC, because if they have a good program, that body will be an ally and if they don't, they will be stopped at the FDA in any case. But if by mischance the ARAC becomes bogged down or otherwise fails to work properly, another option would be available.) We consider the ARAC especially important because it creates a public body with official status to determine which drugs in clinical trials should become more available. Other Parts of the Parallel-Track Proposal Besides ARAC, the parallel-track proposal also calls for: * Creation of a national IRB (Institutional Review Board) for the parallel-track protocols. While local IRBs could still review any protocol, the national IRB could avoid delays and other problems which would result from relying only on the local groups. Until the national IRB is established, the ARAC will appoint a subcommittee to do its job temporarily. * Emphasis on education of physicians and potential participants in parallel-track programs, to make sure that physicians are informed on how to use the drugs, and that the risks and benefits of participating are understood. * Use of existing IND regulations to allow pharmaceutical companies to recover costs in some cases by charging for participation, but only " in the unusual circumstance in which the trial could not continue" (without charging fees), and only with the permission of the FDA. * Criteria for terminating parallel-track access to a particular drug, for example if there is unreasonable risk to participants, if a better product becomes available, or if the parallel-track access interferes with clinical trials of any drug. The parallel-track proposal as now published will apply only to HIV-related drugs at this time. It is, however, described as a pilot effort; if successful it could be expanded to include treatments for other diseases also. Address for Comments Comments about the parallel-track proposal can be sent to: Parallel Track Policy, National AIDS Program Office, 200 Independence Avenue SW, Room 738-G, Washington, DC 20201. For more information, write to Dr. Valerie Satlow at the above address, or call Dr. Satlow or Donald Pohl at 202/472-4248. We believe that the existing parallel-track proposal is the best we can get at this time and should be accepted as is; changes can be made later, if needed. We are concerned that opponents of expanded access may try to weaken the parallel track to make it less useful, as they did with the "treatment IND" regulations which became effective three years ago but have had limited use since. ***** CONSENSUS STATEMENT: AIDS GROUPS SEEK BETTER RESEARCH PRIORITIES Over 45 major AIDS and health organizations (see list below) have endorsed a consensus statement, "HIV/AIDS Biomedical Research Priorities: Recommendations to the National Institutes of Health." Some of the highlights: * Three areas of HIV research -- prevention, treatment, and health care must all be strengthened. * Of all the research proposals approved for funding by NIH peer review, only 24 percent are actually funded, due to lack of money. This proportion should be raised to 40-50 percent, as in was in the early 1970s. * Three particular areas singled out for increased funding include community-based research, the National Cooperative Drug Discovery Groups for Opportunistic Infections, and NIH salary levels and training grants. * Improved coordination of AIDS/HIV research is needed, through the Secretary of Health and Human Services. * The ACTG (AIDS Clinical Trials Group) should focus on (small) technology-intensive phase I/II studies, with more new compounds than tested in the past. Larger, later trials should be sponsored by pharmaceutical companies, through community- based or other research groups. Other recommendations concern focus on opportunistic infections, a national AIDS research database on disease progression, outreach to excluded groups, trials and other research concerning women and children, methodological research to improve trial designs, acceptance and implementation of the "parallel track" (see article above), community advisory panels at each ACTG site, publication of NIH guidelines for state-of- the-art medical care, NIH help to researchers in speedy dissemination of their results, full disclosure of all consulting or equity relationships between pharmaceutical companies and researchers involved in setting national AIDS research priorities, and reimbursement for the cost of standard medical care associated with trials by Medicare, Medicaid, or private insurance. The organizations endorsing the consensus statement are: AID Atlanta AIDS Action Committee of Massachusetts AIDS Action Council AIDS Coalition to Unleash Power (ACT UP)/NY AIDS Foundation of Chicago AIDS National Interfaith Network AIDS Project Los Angeles (APLA) American Academy of Pediatrics American Anthropological Association's Task Force on AIDS American Association for Counseling and Development American Association for Marriage and Family Therapy American Federation of State, County and Municipal Employees American Foundation for AIDS Research (AmFAR) American Red Cross Association of Schools of Public Health Center for Women's Policy Studies Child Welfare League of America Chronic Fatigue Syndrome Information Institute, Inc. Citizen's Commission on AIDS Coalition for Compassion/Los Angeles Community Research Initiative (CRI)/New York Consortium of Social Science Associations Dallas Gay Alliance/AIDS Resource Center Federation of Parents and Friends of Lesbians and Gays Gay Men's Health Crisis (GMHC)/New York Human Rights Campaign Fund (HRCF) International Association of Fire Fighters Lambda Legal Defense & Education Fund Minority Task Force on AIDS/New York Mobilization Against AIDS/San Francisco National AIDS Network (NAN) National Assembly of State Arts Agencies National Association of Community Health Centers, Inc. National Association of People with AIDS (NAPWA) National Association of Protection and Advocacy Systems National Association of Social Workers National Association of State Alcohol and Drug Abuse Directors National Gay and Lesbian Task Force National Hemophilia Foundation National Minority AIDS Council National Network of Runaway and Youth Services Pediatric AIDS Foundation People With AIDS (PWA) Health Group/New York Planned Parenthood Federation of America Project Inform/San Francisco San Francisco AIDS Foundation Synagogue Council of America Women and AIDS Resource Network (WARN)/NY Copies of the recommendations can be obtained from the AIDS Action Council (212/293-2886), or from the American Foundation for AIDS Research (212/719-0712, ask for Spencer Cox). Note: We consider this consensus statement an excellent summary of improvements needed in AIDS research. ***** TOXOPLASMOSIS UPDATE by Denny Smith Opportunistic infections of the protozoan Toxoplasma gondii are usually controlled by the standard therapies, pyrimethamine with sulfadiazine, or pyrimethamine with clindamycin for people who are allergic to sulfa drugs. (The toxicity of pyrimethamine can be countered with leucovorin). These drugs kill the mature parasites but unfortunately not the cysts from which more protozoa will emerge. So the treatments must be continued indefinitely on a "chronic suppressive" basis. Even during maintenance therapy, relapses are not uncommon. Researchers at the University of Geneva reported last month that doxycycline, a commonly prescribed antibiotic, worked better than pyrimethamine for protecting mice infected with T. gondii (Chang and others, 1990). A combination of the two worked better than either drug alone. We could not find any physicians in this country who had tried doxycycline to treat patients with toxoplasmosis, even though an abstract of the Swiss work was presented last September in Houston at the Twenty-Ninth Interscience Conference on Antimicrobial Agents and Chemotherapy. Doxycycline may provide an option in future situations when the standard drugs fail. Neither could we find anyone who had tried the other possibilities sometimes discussed for use against toxoplasmosis: arprinocid, azithromycin or trimetrexate. AIDS TREATMENT NEWS #79 reported at length on these and other aspects of this infection, and although that was over a year ago, little has changed to improve significantly the survival rates for this diagnosis. We hope that the upcoming International Conference will report experience with new treatments. Some success has been obtained with fresh applications of the drugs at hand. Using an idea presented at the last International Conference in Montreal, Larry Waites, M. D. of San Francisco has improved the outlook for his patients by pulse- dosing the treatments for toxoplasmosis, giving them two times a week instead of daily (see Pedrol, E and others, 1989). Another source of optimism comes from trials now under consideration which would try low doses of pyrimethamine or clindamycin to prevent reactivation of latent infections in patients at risk. Fansidar has been tried as a prophylaxis, but this drug has been associated with fatal allergic reactions in some people. Fansidar was discussed at length in the January issue of Treatment Issues, published by the Gay Men's Health Crisis in New York, and again in the May issue of BETA, published by the San Francisco AIDS Foundation. The notion of some prophylactic measure makes sense for people with HIV who have been exposed to T. gondii if the risk of side effects from such therapy is outweighed by the benefit of preventing disease. Prophylaxis is already the norm for people at risk for Pneumocystis pneumonia (using septra, dapsone or aerosol pentamidine), and is gaining interest for suppressing latent infections of MAI (clofazimine or ansamycin) and Cryptococcus (fluconazole). Incidentally, although all of these microbes are widely present in the environment, T. gondii could be the easiest to avoid, since many people acquire the infection by eating undercooked meat. Also, cats are the natural hosts of the parasite's reproductive cycle. All HIV+ people should avoid contact with cat feces, whether or not they test positive for past exposure. Careful hand washing is critical after handling a pet cat and before eating or preparing food. Toxoplasmosis usually presents itself as encephalitis, an inflammation of the brain from lesions caused by T. gondii. Robert Neger, M. D., reported in April to the Community Consortium in San Francisco the less frequent but real danger of retinal and optic nerve manifestations. This would be of obvious interest to other ophthalmologists who are consulted by HIV+ patients reporting vision problems which ordinarily would be approached as CMV retinitis. Dr. Neger noted that the most complete exam of the retina must use indirect ophthalmoscopy, after dilating the pupils. A contrasting example of misdiagnosis was presented to the Community Consortium last January. Martin Mass, M. D., discussed the case of a patient who showed symptoms of neurological problems memory loss and walking balance difficulty. An MRI scan showed multiple brain lesions, but this scan cannot distinguish toxoplasma infections from lesions caused by PML, herpes or lymphoma. The patient's bloodwork tested positive for antibodies to T. gondii, and in accordance with standard practice, he was started presumptively on drugs to treat toxoplasmosis. Unfortunately, his condition did not improve, and a subsequent brain biopsy identified the lesions conclusively as lymphoma. Dr. Mass suggested that if biopsies were performed earlier for patients with neurologic symptoms, the resulting diagnosis would be more accurate and treatment more timely. Other physicians discussing the case felt that the current three-week trial of presumptive toxo treatment is still appropriate. We wonder why the development of new toxoplasmosis therapies and prophylaxes appears to be so snail-paced. Perhaps the existence of an already-approved treatment regimen translates into a disincentive for pharmaceutical companies which are primarily interested in first-line drugs targeted for large "hostage" markets. If this is true, patients who cannot tolerate the approved treatments, or who face drug- failure relapses are casualties of the ubiquitous "health for profits" motivating medical research today. This epidemic will be haunting the world for decades to come unless that motivating force of research is replaced by "health for people." We plan to report developments, or the vacuum of developments, in treating toxoplasmosis and other opportunistic infections after the International Conference later this month. References Pedrol, E and others. Central nervous system toxoplasmosis in AIDS patients. Efficacy of an intermittent maintenance therapy. V International Conference on AIDS, abstract M. B. O. 37, Montreal, June 5, 1989. Chang, HR and others. In vitro and In vivo effects of doxycycline on Toxoplasma gondii. Antimicrobial Agents and Chemotherapy, volume 34, number 5, pages 775-780, May, 1990. ***** COMPOUND Q: CONTINUING GOOD NEWS by Denny Smith Anecdotal reports and at least one published article point to continued optimism around the use of trichosanthin, or compound Q, against HIV. AIDS TREATMENT NEWS has heard from at least three people who have experienced significant improvement in blood values and HIV-related symptoms since trying compound Q. All three were given the drug under the supervision of a knowledgeable physician, and none of them experienced any serious side effects. However, many instances of toxicity have been attributed to trichosanthin, and the physicians most familiar with the drug strongly advise against self-administration. Drs. Larry A. Waites, Vera S. Byers and Alan S. Levin have issued a public letter explaining this advice; their offices can be reached at 415/788-4535. Their clinic is willing to consult with other physicians interested in trichosanthin infusion information. In addition to positive anecdotal reports, Project Inform has published an "interim update" of its "underground" trial of last year, as well as a description of a new trichosanthin protocol designed by the recently merged Project Inform Community Research Alliance (PICRA) and sanctioned by the FDA. Both reports appear in the May 1990 issue of PI Perspective. The first study organized by Project Inform used trichosanthin imported from China. Several buyers' clubs around the U. S. have since started to make the same product available. The PICRA study will use trichosanthin supplied by Genelabs, a California pharmaceutical manufacturer. (To obtain the May issue of PI Perspective, call Project Inform, 415/558-9051, or 800/334- 7422 toll-free from within California, or 800/822-7422 toll-free from elsewhere in the U. S.) Meanwhile, four other sites in the San Francisco area continue other trichosanthin studies, also using drug provided by Genelabs. PICRA and San Francisco General Hospital are each expected to report on their trials at the International Conference later this month. ***** SIXTH INTERNATIONAL CONFERENCE NEWS ACT UP/ACT NOW Calendar The AIDS Coalition to Network, Organize, and Win (ACT NOW), a San Francisco based organization for communication among different ACT UP and similar groups around the world, is sponsoring or co-sponsoring workshops, demonstrations, and other events before and during the Conference. * Sunday, June 17, day of workshops at the San Francisco Women's Building (3543-18th St., at Valencia St.). * Workshops on newsletter production; racism, drugs, and AIDS; U. S. immigration policies; the Christian right wing; and alternative treatments, 11:00 a.m. to 12:30 p.m. * Organizing forum, 2:00 p.m. to 5:00 p.m. * Workshops on organizing a needle-exchange program; international AIDS organizing; AIDS and lesbian/gay liberation; and reproductive rights and AIDS activism, 7:30 p.m. to 9:00 p.m. * Monday, June 18, San Francisco Women's Building. All day activist meeting for planning and preparation for demonstrations, press conferences, etc. * Tuesday, June 19, demonstration against U. S. immigration policies. A march to the San Francisco office of the U. S. Immigration and Naturalization Service will gather beginning at 4:00 p.m. at Sansome and Market Streets. * Wednesday, June 20, demonstration during Conference opening, 1-5 p.m., corner of Howard and Third Streets near the Conference site. * Also, Wednesday 6 p.m. to 10 p.m. at the Women's Building there will be another activist orientation for those arriving late, and to plan last-minute actions. * Thursday, June 21, demonstration to focus on the "San Francisco model." Gather at 11:00 a.m. at the old Federal Building , 50 United Nations Plaza (the site of the AIDS/ARC Vigil). * Friday, June 22, actions planned to address women and AIDS. Gather at 4:30 p.m., Fourth and Market Streets. * Saturday, June 23, major HIV/AIDS march called by a coalition of community groups including: ACT NOW, ACT UP/Los Angeles; ACT UP/San Francisco; AIDS Service Providers of the East Bay; American Association of Physicians for Human Rights; Asian Pacific AIDS Coalition; Bayview Hunters Point Foundation; Black Coalition on AIDS; Coalition for Immigrant and Refugee Rights and Services; Gay Asian Pacific Alliance; Glide Memorial Methodist AIDS Project; Latino Coalition on AIDS/SIDA; Lutheran Lesbian/Gay Ministry; Mobilization Against AIDS; Operation Concern; PWA Association of San Francisco; Project Inform; San Francisco AIDS Foundation; San Francisco Interreligious Coalition on AIDS; Stonewall Gay Democratic Club; Visiting Nurses and Hospice of San Francisco; and Women's AIDS Network. Other groups may be added as co-sponsors. Assembly begins at 9:30 a.m., at Justin Herman Plaza (foot of Market Street near the Ferry Building); the march will proceed up Market to the Civic Center area. For more information, call the office of the HIV/AIDS march, 626-5676. * Sunday, June 24. A demonstration during the Conference closing is being scheduled so that participants can also get to the Lesbian and Gay Freedom Day parade on that day. In addition, ACT NOW parties are planned on Sunday, Tuesday, Wednesday, Thursday, and Friday. ***** San Francisco: Housing Needed for Activists If you can provide housing for ACT UP/ACT NOW members, at any times during the period of June 15 through June 25, call Bob Smith, 255-9790. AIDS Activist International Contact List ACT NOW is in touch with AIDS activist organizations in the following cities or areas. International: Amsterdam, Berlin, Brighton, Edinburgh, Glasgow, Leeds, London, Paris, Sydney, and Toronto. In the U. S.: Albany, Ann Arbor, Atlanta, Austin, Boston, Bloomington, Cape Elizabeth, Chicago, Cincinnati, Coconut Grove, Columbus, Dallas, Denver, Detroit, Hartford, Houston, Kansas City, Long Beach, Long Island (Westbury), Los Angeles, Madison, Miami, Milwaukee, Minneapolis (two organizations), Nashville, New Orleans, New York, North Lauderdale, Oakland, Oklahoma City, Orlando, Philadelphia, Pittsburgh, Portland, Providence, Provincetown, Rochester, San Diego, San Francisco (two organizations), Seattle, Shreveport, Syracuse, Tallahassee, Washington DC (two organizations), and Wichita. Also, three counties in California: Contra Costa, Orange, and Sonoma. For More Information For more information about events during the conference, or how to contact AIDS activists in your area, call ACT NOW in San Francisco, 415/861-7505, or fax to 415/863-4740. Arts Events Sponsored by 69 Hours "69 Hours," which is associated with the international computer link described below, is sponsoring two events in San Francisco during the conference: * Personal and Political Performances on AIDS, two different performances on Friday and Saturday, June 22 and 23 at New Langdon Arts, 1246 Folsom St. $5 donation requested, but no one turned away for lack of funds. * A gallery show dealing with the epidemic will be open at the Capp Street Project, 270 14th St., June 21-24. For hours and other information, call 626-7747. ***** INTERNATIONAL PUBLIC COMPUTER LINKS DURING CONFERENCE During the time of the Sixth International Conference in San Francisco, public-access computer terminals in Amsterdam, New York, San Francisco, and possibly other locations will provide AIDS information and international communication. Easy-to-use Apple Macintosh computers will allow members of the public to read pre-prepared AIDS information, to read messages entered in any of the different cities, and to enter their own messages. In Amsterdam the Seropositive Ball, "a comprehensive cultural and political manifestation for people with and without AIDS," will organize live meetings, as well as access to the international computer network, at the Paradiso cultural center. Currently the sites planned for public-access terminals are: * Amsterdam: Paradiso; Time Based Arts Gallery; Academic Medical Center; Vrolijk Bookstore. * New York: Simon Watson Project Space; New York Hospital/Cornell Medical School. * San Francisco: Marriott Hotel; Capp Street Project; San Francisco General Hospital. (The sites in San Francisco will be organized by 69 Hours/On Line Against AIDS.) The Seropositive Ball will include Art On Line for AIDS, and also the International Conference on the Alternative Use of Technology for AIDS (ICATA'90). The three-city international computer network described above is scheduled to run from June 21 to June 24. Any Apple Macintosh computer with modem and disk can connect to this network; volunteers are needed to support these computers in various locations. If you have Macintosh experience and would like to assist or would like the software to connect to this network, please contact one of the people below. For more information, call Rolf Pixley in Amsterdam, 31-20- 264-521, or fax to 31-20-222-721. Or call Jan Zita Grover, 415/271-8466, or Mark Graham, 415/346-4188, both in San Francisco. ***** ANNOUNCEMENTS TRIALS COMBINING AZT AND DDI NOW RECRUITING New clinical trials investigating the safety and effectiveness of various AZT/ddI combinations are open to participation at sites in Boston (Principal Investigator Paul Skolnik, M. D.), Miami (Margaret Fischl, M. D.), Seattle (Lawrence Corey, M. D.), and San Francisco (Don Northfelt, M. D. and Lawrence Kaplan, M. D.). Larger trials comparing ddI to AZT have been in place for some time, but these are the first trials to combine the two drugs. These are Phase I (testing for toxicity) studies, and will try five separate dosage combinations ranging from 45 mg of ddI twice a day given with 50 mg of AZT three times daily, to 250 mg of ddI twice a day with 200 mg of AZT three times daily. No placebos are involved. The San Francisco trial only (not the trials at the other sites) will include three separate lumbar punctures over the course of the study, to measure the quantity of drug reaching the cerebrospinal fluid. They will be done by experienced physicians and should pose minimal discomfort. For information regarding entry criteria, interested persons may call Marca Wilk, R. N., at the New England Medical Center, 617/956-5114, beeper 1267; the protocol screening number at the University of Miami AIDS Clinical Research Unit, 305/547- 3838; Jeanne Conley, R. N., at Harborview Medical Center, 206/223-3184; or Kit Boggio, R. N., at San Francisco General Hospital, 415/821-5089. This trial is sponsored by Burroughs- Wellcome. Note: This is a small study, and only a few positions are open at each center. ***** START-UP GRANTS FOR CARE OR SUPPORT TO PEOPLE WITH AIDS People Taking Action Against AIDS (PTAAA), which runs a successful fundraiser each summer in Bellport, Long Island, is accepting applications for start-up grants for newly-formed groups offering care or support to people with AIDS especially groups outside of major metropolitan areas. Applicants should submit a brief description of their organization's activities and goals no later than August 1. Send requests to Don Hall, PTAAA, Box 378, Bellport, New York, 11713. For more information, call 212/505-1350. * Note: This summer's event, "Sunday by the Bay," will be July 8th in Bellport. For directions and ticket information, call 516/286-1020. ***** STATEMENT OF PURPOSE AIDS TREATMENT NEWS reports on experimental and complementary treatments, especially those available now. It collects information from medical journals, and from interviews with scientists, physicians, and other health practitioners, and persons with AIDS or ARC. Long-term survivors have usually tried many different treatments, and found combinations which work for them. AIDS Treatment News does not recommend particular therapies, but seeks to increase the options available. We also examine the ethical and public-policy issues around AIDS treatment research and treatment access. [Obsolete subscription information has been removed. See the latest issues for up-to-date information. -- sysop] &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& End of display