Subject: AIDS Treatment News #115 Date: Nov 27 1990 (750 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 #115, November 23, 1990 phone 415/255-0588 CONTENTS: [items are separated by "*****" for this display] ddC/AZT Combination: Promising Early Results Acyclovir Resistant Herpes: New Treatment Option? PML: Updated Report Available Glycyrrhizin: Correction and Update Pneumocystis Steroid Controversy Women and HIV Conference, December 13-14, Washington, DC World AIDS Day: Women and AIDS New York: Forum on MAI and Tuberculosis San Francisco: Public Forum on Pneumocystis Prophylaxis AIDS Treatment News Outreach Assistance Requested ***** DDC/AZT COMBINATION: PROMISING EARLY RESULTS by John S. James Preliminary results from a dose-finding trial of combination treatment with ddC and AZT suggest that the two drugs together, in small or moderate doses, may work better than standard treatment with AZT alone. These results must be interpreted carefully, however, because the study is still incomplete, and final verification and analysis has not been done; also, it is relatively small, with 48 volunteers. This article reports on the information from this study which has already become publicly known. The Federally sponsored trial, ACTG 106, is being conducted in Miami and San Diego; principal investigators are Margaret A. Fischl, M. D., and Douglas D. Richman, M. D. The 48 volunteers all had AIDS or advanced ARC, with T-helper counts under 200 when they entered the study. Six different treatment regimens are being compared; the 48 volunteers are divided into six groups of eight each. Five of the six treatment arms combine ddC and AZT; the sixth uses a very low dose of AZT alone. The doses (in milligrams, given every eight hours) are: AZT ddC 200 0.750 200 0.375 100 0.750 100 0.375 50 0.750 50 none Since these amounts are given three times a day, the total AZT doses are 600, 300, and 150 mg per day. The high ddC dose is the same as that now being used in the major ddC vs. AZT comparison trials, and the low ddC dose is half that amount. Volunteers were first assigned to the four arms with the higher AZT doses (600 or 300 mg per day). Some groups have been on the treatment for over a year, others for less time. We have not seen the data, which will of course change as the study progresses. The following overview comes from a recent Project Inform fact sheet, and other published sources cited in the references below. Results Large T-helper increases were found. The Project Inform report cited a median peak increase of 164; the exact figure will change as the study progresses. After reaching this peak, T- helper counts began to decline. We have heard conflicting reports about how far the counts declined, but it is clear that they are above the starting value after one year of the treatment. Both the size of the increase, and the time it was sustained, are much better than with AZT treatment alone -- especially for this group of patients, whose median starting T- helper count was under 100. Also, 100 percent of patients in the four treatment arms with the higher AZT doses (600 or 300 mg per day) combined with ddC had increases of at least 50, measured on at least two consecutive tests. These results strongly suggest that the combination treatment has a greater antiviral effect than AZT alone. What about clinical improvement? Few opportunistic infections have occurred in the study, and all of them occurred within the first few weeks of treatment -- none within the remaining time, about 50 weeks for many patients. This clustering of infections early in the study strongly suggests that the regimen was helpful, since with no treatment, the rate of infections would, if anything, have increased. The early infections may have been developing before the treatment's benefit had time to begin. Other clinical improvement was also reported, with median weight gain of about 9 pounds. Tests will soon be run to look for changes in plasma viral levels, and to see if drug resistance develops during the combination treatment. The researchers do not yet have this information. What Should Be Done? The results already known from ACTG 106 suggest that the combination treatment with ddC and AZT may be substantially better than any standard therapy (i.e., AZT alone), for many patients at least. We do not have conclusive proof, however, because of the relatively small number of volunteers in this study, and because the combination was not directly compared to a standard dose of AZT. Also, this study does not answer the question of how best to use ddC for patients now failing AZT. What will happen now? The usual procedure would be to run more studies, after finishing this one; with luck, conclusive proof might be available in two years. The problem, of course, is that many people do not have that time to wait. Note that this study applies most directly to those whose HIV infection is relatively advanced. What should be done is to convene a panel of experts, give them access to all the existing data on ddC and ddI, from all completed and ongoing studies, along with the technical support staff necessary so that they can analyze it. They should be asked whether physicians could provide better care for persons with AIDS or HIV if they had these drugs available, than if they continue to have only AZT. If the answer is yes, for ddC or ddI or both, then the drug(s) should quickly be approved for prescription use, with appropriate labeling, including an explanation of the available evidence which led to approval, and the panel's recommendations to physicians concerning use of the drugs. After approval, postmarketing studies should answer the remaining questions, such as how to best use the drugs for particular patient populations. (Is it better, for example, for patients who have used AZT but are now failing it to switch to ddC or ddI alone, to one of those drugs in combination with AZT, or to alternating use of the drug and AZT?) Comment A number of other studies of human use of ddC are either published, in press, or in process. ddC is being tested alone, in comparison with AZT, and in alternation with AZT. In addition, there are similar studies with ddI; however, the ddI-AZT combination study started later than ACTG 106, so little information is now available. (There is more information now about ddI as a single agent, however, than about ddC; for a review of a recent ddI report, see AIDS TREATMENT NEWS #110, September 7, 1990.) Currently, the open-access programs for ddI and ddC have made these drugs available to many patients who cannot use AZT. But these programs are limited because their strict entry criteria exclude many patients who could benefit, without taking individual circumstances into account. Also, they do not allow combination use with AZT -- which now seems to be emerging as the best way to use these drugs. And the paperwork required of physicians effectively makes these drugs unavailable to many patients. The largest ddC and ddI studies are usually set up to compare each of these drugs with AZT. These trials were designed this way because it would have been unethical to test ddC or ddI in a placebo trial, when the standard of care is now AZT. But how these drugs compare to AZT is usually the wrong question, since generally the new drugs will be used for patients who cannot benefit from AZT, or in combination with that drug. The right question is whether physicians can give better care if they have these drugs available in addition to AZT. The references below list many papers which have already been published on human use of ddC in HIV treatment. But the most important studies are now ongoing. It is urgent that the existing information be brought together and evaluated now, leading to drug approval if appropriate. It would be tragic to wait a year, two years, or more for approval of ddC and ddI, when people need treatment options now. References Note: This list is not complete. Only the more relevant articles on human use of ddC -- especially together with AZT -- are included. American Foundation for AIDS Research. AIDS/HIV Treatment Directory. September, 1990; pages 18-19, 43. Also see June, 1990; pages 28-29. Bozzette SA and Richman DD. Salvage therapy for zidovudine- intolerant HIV-infected patients with alternating and intermittent regimens of zidovudine and dideoxycytidine. American Journal of Medicine. May 21, 1990; volume 88, supplement 5B, pages 24S-26S. Bozzette S, Skowron G, Arrezo J, Spector SA, Pettinelli C, and Richman DD. Alternating and intermittent ddC and AZT in the treatment of persons with advanced HIV infection and hematologic intolerance to AZT [abstract S. B. 425]. Sixth International Conference on AIDS, San Francisco, June 20-24, 1990. Broder S. Pharmacodynamics of 2',3'-dideoxycytidine: an inhibitor of human immunodeficiency virus. American Journal of Medicine. May 21, 1990; volume 88, supplement 5B, pages 2S-7S. Broder S, and Yarchoan R. Dideoxycytidine: Current clinical experience and future prospects -- A summary. American Journal of Medicine. May 21, 1990; volume 88, supplement 5B, pages 31S- 33S. Dubinsky RM, Yarchoan R, Dalakas M, and Broder S. Reversible axonal neuropathy from the treatment of AIDS and related disorders with 2',3'-dideoxycytidine (ddC). Muscle and Nerve. October, 1989; volume 12, number 10, pages 856-860. Kolata, Gina. Interest grows in licensing shortcut for 2 AIDS drugs. The New York Times, Medical Science section, September 25, 1990. Meng TC, Boota A, Fischl MA, Spector SA, McCaan M, and Richman DD. Phase I/II dose finding study of concurrently administered dideoxycytidine and zidovudine [abstract S. B. 426]. Sixth International Conference on AIDS, San Francisco, June 20- 24, 1990. Meng TC, Fischl MA, and Richman DD. AIDS Clinical Trials Group: phase I/II study of combination 2',3'-dideoxycytidine and zidovudine in patients with acquired immunodeficiency syndrome (AIDS) and advanced AIDS-related complex. American Journal of Medicine. May 21, 1990; volume 88, supplement 5B, pages 27S-30S. Merrigan TC, Skowron G, Bozzette SA, and others. Circulating p24 antigen levels and responses to dideoxycytidine in human immunodeficiency virus (HIV) infections. Annals of Internal Medicine. February 1,1989; volume 110, pages 189-194. Merrigan TC and Skowron G. Safety and tolerance of dideoxycytidine as a single agent. Results of early-phase studies in patients with acquired immunodeficiency syndrome (AIDS) or advanced AIDS-related complex. American Journal of Medicine. May 21, 1990; volume 88, supplement 5B, pages 11S- 15S. Pizzo PA. Treatment of human immunodeficiency virus-infected infants and young children with dideoxynucleosides. American Journal of Medicine. May 21, 1990; volume 88, supplement 5B, pages 16S-19S. Project Inform, San Francisco. News bulletin, "Combination Therapy," November, 1990. Richman DD. Susceptibility to nucleoside analogues of zidovudine-resistant isolates of human immunodeficiency virus. American Journal of Medicine. May 21, 1990; volume 88, supplement 5B, pages 8S-10S. Shirasaka T, Yarchoan R, Aoki S, and others. In vitro study of drug-sensitivity of HIV strains isolated from patients with AIDS or ARC before and after therapy with AZT and/or 2',3'- dideoxycytidine (ddC) [abstract Th.A. 263]. Sixth International Conference on AIDS, San Francisco, June 20-24, 1990. Skowron G, and Merrigan TC. Phase II trial of alternating and intermittent regimens of zidovudine and 2',3'-dideoxycytidine in ARC and AIDS [abstract Th.B. 23]. Sixth International Conference on AIDS, San Francisco, June 20-24, 1990. Skowron G, and Merrigan TC. Alternating and intermittent regimens of zidovudine and dideoxycytidine in the treatment of patients with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex. American Journal of Medicine. May 21, 1990; volume 88, supplement 5B, pages 20S-23S. Yarchoan R, Pluda JM, Thomas RV, Pemo CF, McAtee N, and Broder S. Long-term (18 month) treatment of severe HIV infection with an alternating regimen of AZT and 2',3'- dideoxycytidine (ddC) [abstract W. B. P. 327]. Fifth International Conference on AIDS, Montreal, June 4-9, 1989. ***** ACYCLOVIR RESISTANT HERPES: NEW TREATMENT OPTION? by Michelle Roland Three anecdotal case reports have recently come to our attention about a potentially effective treatment for acyclovir- resistant herpes. The treatment, an ophthalmic (eye) solution called trifluridine (also called Viroptic, or trifluorothymidine), is available by prescription. It is currently used to treat patients with herpes simplex keratitis, an infection of the cornea of the eye. The only published report on trifluridine treatment of acyclovir-resistant herpes in a person with HIV infection was presented at the Sixth International Conference on AIDS in San Francisco in June, 1990 [Doherty and others, abstract Th.B. 446]. This patient first had acyclovir-resistant herpes lesions which responded to foscarnet. However, a subsequent lesion was resistant to both acyclovir and foscarnet. Two other topical treatments (idoxuridine cream; interferon gel alone) were tried but failed in this patient before she responded to the combination of trifluridine and interferon with "considerable but incomplete healing." Two other cases were discussed by Harold Kessler, M. D., from Rush-Presbyterian St. Luke's Medical Center in Chicago, at the recent meeting of the AIDS Clinical Trials Group (ACTG) in Washington, D. C. (The ACTG is a research program of the National Institute of Allergy and Infectious Diseases of the National Institutes of Health; it is the group which conducts the bulk of the Federally sponsored AIDS clinical research in this country.) Dr. Kessler emphasized that there is no proof that trifluridine is effective in acyclovir-resistant herpes, because there have been no studies of this treatment. In addition, he knows of a total of only four episodes of herpes in three patients who were treated with this drug. However, he agreed that this information should be made available to patients and physicians before the completion of a controlled study since there are few alternative treatments currently available to people with herpes lesions that are resistant to both acyclovir and foscarnet. Dr. Kessler described applying a thin film of the solution over a well-cleansed lesion. He then covered the lesion with a thin layer of Polysporin ointment to keep the solution in contact with the lesion. Gauze was placed over the lesion. The medication and dressing were changed three times a day. One patient (with a lesion of three by four centimeters) responded in four to five weeks. This patient relapsed with a lesion that was next to the original one. The second lesion healed within two weeks with treatment with trifluridine. A second patient was treated at another medical center and had a complete response in two weeks. Dr. Kessler emphasized that this treatment is not a cure for herpes simplex infections. New lesions will occur after treatment with any anti-herpes drug. However, new lesions may be susceptible to acyclovir and/or foscarnet. An open-label prospective study of this drug is being designed for people with chronic cutaneous herpes which is suspected of being acyclovir resistant. In the meantime, Dr. Kessler has requested that physicians trying trifluridine send viral isolates for acyclovir and foscarnet resistance testing to his laboratory in Chicago so that the effectiveness of trifluridine can be assessed before the official study is under way. Physicians can reach Dr. Kessler at 312/942-5865 (Division of Infectious Diseases, Rush-Presbyterian St. Luke's Medical Center, Chicago). ***** PML: UPDATED REPORT AVAILABLE A severe opportunistic viral infection of the brain called progressive multifocal leukoencephalopathy (PML) has long been considered by the medical establishment to be untreatable. But over a year ago Los Angeles activists Lisa and Peter Brosnan published a compilation of literature discussing experimental treatments for PML (see AIDS TREATMENT NEWS #79, #88 and #100), and they have recently completed an expanded, updated edition. The new report includes case histories collected by the authors, the results of an informal PML survey which they conducted earlier this year, a discussion of the known potential treatments, and several articles reprinted from recent medical literature. Requests for the report can be sent to 3031 Angus Street, Los Angeles, CA 90039. Urgent requests can be called in to 213/666-0751. The cost of copying and mailing the report is $25 for first class delivery, or $30 for express mail. Persons with AIDS are offered the report for $15, for either kind of mailing; it will be sent free if necessary. Although no single drug has been proven to treat PML, no one facing this diagnosis should be told that there is nothing at all to try. Acyclovir, cytarabine, dexamethasone, heparin, interferon, NAC, and vidarabine have all been tried against PML with varying degrees of success. Peter and Lisa's first report undoubtedly saved lives over the past year, and the new edition promises to build on that accomplishment. ***** PNEUMOCYSTIS STEROID CONTROVERSY by John S. James On November 14 The New York Times published a front-page story alleging that news of a consensus panel's recommendation for using steroids in treating certain cases of pneumocystis had been delayed for five months, in part because researchers feared that announcing the information earlier would jeopardize publication of their results in prestigious medical journals. Much press and television coverage followed; The New York Times published a followup story on November 16, and a brief note on November 18 ("The Week In Review" section). AIDS TREATMENT NEWS was credited with bringing this story to public attention; our role, however, was minimal, as everything we reported came from a press release and note to physicians from the U. S. National Institute of Allergy and Infectious Diseases (NIAID). We had refrained from adding any comment of our own, as we were torn between criticizing the delay and praising NIAID for calling the consensus panel in the first place and disseminating the recommendations without waiting for journal publication. In AIDS and in other diseases as well, there is a great need for a respected body to determine when a health emergency exists, call experts together to recommend appropriate changes in the standard of care, and then get the recommendations promptly to the physicians who need them. There is legitimate concern that some researchers or officials may be blamed unjustly for delaying news of the steroid decision. The consensus panel met in May, and NIAID released the results in October. However, there were serious medical issues concerning the recommendations, issues which could not be resolved in a day. Meanwhile, much of the steroid information was publicly available, having been reported at medical meetings and in some journal articles; in San Francisco, a survey by the Community Consortium found that 67 percent of their physicians who responded had already used steroids in this situation. We are not close enough to this issue to know what, if anything, should have been done differently to disseminate the information more rapidly. Yet the issues raised by these events are clearly real ones. There are glaring deficiencies in how new medical information is communicated to physicians. Some problems do stem from news embargos imposed by some medical journals; many researchers do not believe the public assurances that these embargos do not apply to AIDS or other emergencies. Other problems occur after publication; for example, there are thousands of journals, and physicians have little time for reading. European journals, for instance, often never come to the attention of the U. S. medical community. The development of professional bodies to cut through the noise and focus on what is most important seems to be hindered by the tendency of such groups to be too conservative (the safest position for guarding against future lawsuits or criticism). All too often the final result is a medical mainstream ignorant of relevant research -- surrounded by mavericks often working on the fringes of respectability. This system poorly serves the public interest. The recent controversy over steroid use in pneumocystis succeeded where other efforts failed in alerting all physicians to this treatment development. It also made clear that the public will not stand for unnecessary withholding of lifesaving information. And hopefully it will focus professional attention on the larger problems in medical communication, and on how the dissemination of urgent treatment information can be improved. ***** GLYCYRRHIZIN CORRECTION AND UPDATE by Denny Smith Last May 18, in issue #103 of AIDS TREATMENT NEWS, we published an article on the experimental treatment glycyrrhizin. Since then, we received a communication from Paul Bergner, the editor of Medical Herbalism, correcting two points made in that report. The first error in our article regards the exact chemistry of glycyrrhizin. While we believed that it was one of the sulfated polysaccharides, it is actually considered a glucoside, resulting in a significantly different pharmacological profile. The other inaccuracy involves our inference that glycyrrhizin is used in Europe as a treatment for stomach ulcers. At least some of the European preparations derived from the root of Glycyrrhiza have actually been "de-glycyrrhizinated" for use in treating ulcers, since they rely on other components of the plant for their therapeutic effect. We appreciate these corrections, and any others from concerned readers. Mr. Bergner also mentioned the possible use of the Koenigsburg urine test, which might alert doctors and their patients to possible adverse reactions to glycyrrhizin, before symptoms appear. Persons interested in Medical Herbalism can write to P. O. Box 33080, Portland, OR 97233. Incidentally, we have found that the Japanese product called Glycyron 2 is available at San Francisco's Healing Alternatives Foundation, a buyers' club which is able to handle mail orders. The number for Healing Alternatives is 415/626-2316. ***** WOMEN AND HIV CONFERENCE, DEC. 13-14, WASHINGTON, DC by Laura Thomas There will be a conference on women and HIV in Washington, DC, on December 13-14, 1990. The conference is free, and is targeted at women with HIV, health care providers, and AIDS service providers. The goals of the conference are to: identify research needs, provide up-to-date treatment information on women with HIV and improve the quality of care they receive, identify the social and economic barriers facing women with HIV and how they affect research, and identify community resources and educate participants on the special needs of women at risk. The conference will be organized in four basic tracks: epidemiology, psychosocial and social issues, education and prevention, and treatments and clinical issues. The conference was called by the National Institutes of Health after pressure to do so from AIDS activists, especially the women of ACT UP/New York and ACT UP/DC. While this conference will not be as comprehensive or accessible as we would like, it is at least a recognition on the part of the Government that there is a problem, and it is a step forward for the NIH in dealing with the issues of women and HIV. To register or request more information, call Carol Gordon or Debra Steward at 301/770-0610, or 301/770-3153 after 5 pm Eastern time. Interested people should call immediately to get the registration form and send it in, because registration forms should be in by November 30, and space is filling up fast. Attendance is limited to the first 1,000 people, with 100 spaces reserved for women with HIV. Women with HIV infection should note that on their form. A committee is working to raise money for transportation for women who would not otherwise be able to get to the conference. Individuals who would like to donate money or frequent flyer miles towards travel scholarships can send their donation to: Women and HIV Conference Travel Fund, c/o Denise Rouse, DC Women's Council on AIDS, 725 8th Street, SE, Washington, DC 20003. People interested in possible scholarships should contact Denise Rouse of the DC Women's Council on AIDS at 202/544-8255. The conference is also trying to find free community housing in Washington for women with limited funds. Anyone who lives in the Washington area and is able to house a conference participant for a few days can contact Kate Perkins at 301/496- 0545. Many AIDS activists want to get together Saturday, December 15, after the conference, to share information, compare notes, and plan their next steps. Conference participants who are interested in meeting with other activists, women with HIV, and service providers should plan to stay through Saturday. Information will be posted at the conference as to where this meeting will be. ***** WORLD AIDS DAY: WOMEN AND AIDS by Laura Thomas December 1 is World AIDS Day, and the World Health Organization has chosen "Women and AIDS" as this year's theme. There will be actions and events all over the world to mark the day, many of them focusing on women and HIV. The World Health Organization's very conservative estimate is that there are over three million women with HIV in the world, most of them in Africa. In fact, one in 50 women in sub-Saharan Africa is infected with HIV, and one in 700 in North America. AIDS is the leading cause of death for women ages 20-40 in major cities in the Americas, Western Europe, and Africa. By 1992 over four million infants will have been born to mothers with HIV, and about a million of the babies will themselves be infected. In the United States women are the fastest growing group of people with HIV, yet remain invisible in the epidemic. AIDS is the leading cause of death for women ages 25-34 in New York City, and women with AIDS die four to six times faster than men with AIDS. However, the Centers of Disease Control still refuse to include the opportunistic infections specific to women in their list of AIDS-defining infections. This means that many women with HIV are misdiagnosed or even undiagnosed, and do not receive the treatment or services they need. It also makes it very difficult for women with HIV to get the immediate disability benefits they need once they become sick, and women have died while waiting for their benefits. ACT UP/Network, the national network of direct action AIDS activist groups, has declared November 26-December 3, 1990 a "Week of Outrage." During the week, ACT UP groups across the country will hold demonstrations to draw attention to the issues of women and HIV infection. Chicago, San Francisco, Seattle, Los Angeles, and Austin, are among the cities demonstrating. For more information, contact your local ACT UP, or call Saundra Johnson at 312/829-6797. The Week of Outrage will culminate on Monday, December 3, with a large demonstration at the Centers for Disease Control in Atlanta, to demand that the CDC expand their definition of AIDS to include the infections and symptoms common to HIV-infected women. For more information about the action in Atlanta, contact ACT UP/Atlanta at 404/286-6247. ***** NEW YORK: FORUM ON MAC AND TUBERCULOSIS The Community Research Initiative will hold a one-evening forum on MAC (also called MAI) and tuberculosis, on Tuesday, December 4, 1990, 6:00 p.m. to 11:00 p.m. Topics include azithromycin, liposome-encapsulated gentamycin, prophylaxis, results of a treatment survey, and overview of the epidemiology and treatment of these infections. The forum will be held at the Lesbian and Gay Community Center, 208 West 13th Street, in Manhattan. The Community Research Initiative has requested an optional $50 donation from those able to contribute; however, no admission is required. For more information, call the Community Research Initiative at 212/481-1050. ***** SAN FRANCISCO: FORUM ON PNEUMOCYSTIS PROPHYLAXIS BETA (Bulletin of Experimental Treatments for AIDS), a publication of the San Francisco AIDS Foundation, is sponsoring a free public forum titled, "PCP Prophylaxis: What is the Treatment of Choice?" on Thursday, December 6, 7:30 to 9:30 p.m., at the San Francisco Medical Society Auditorium, 250 Masonic Avenue (near Turk) in San Francisco. Speakers include Marcus Conant, M. D., who has one of the largest HIV practices in San Francisco; Walter Hughes, M. D., from Saint Jude's Children's Research Hospital in Memphis, who will discuss his experience with Bactrim, as well as his research on the new anti-pneumocystis compound 566C80 (see AIDS TREATMENT NEWS #114, November 2, 1990); and Gifford Leoung, M. D., principal investigator of the San Francisco trial of aerosol pentamidine which led to FDA approval of this treatment. A panel of questioners will include Ron Baker (BETA), Michelle Roland (AIDS TREATMENT NEWS), and Harold Cottman, M. D., a San Francisco psychiatrist. The presenters will also take questions from the audience. For more information, call the San Francisco AIDS Foundation, 415/863-2437, 9 a.m. to 9 p.m. Monday through Friday, 11 a.m. to 5 p.m. Saturday and Sunday. ***** AIDS TREATMENT NEWS OUTREACH ASSISTANCE REQUESTED by Tim Wilson Since early this year we have been aware and concerned that many people who could benefit from the information in AIDS TREATMENT NEWS do not have access to it. In June we began developing an outreach campaign in order to reach a larger audience of HIV-impacted populations with our treatment message, and now we request your assistance with this project. As one of our subscribers, you can be part of our support structure and help us succeed in our overall mission of getting the word out about important treatment options and public policy issues. The staff of AIDS TREATMENT NEWS is requesting the assistance of our subscribers in the following outreach areas: * New 800 subscription number. Help us spread the word that interested parties can now call 1-800-TREAT-1-2 (1-800-873-2812) for AIDS TREATMENT NEWS subscription information (Note: this is not a treatment information hotline). Ask your local community AIDS service organizations, HIV testing and counseling centers, buyers' clubs, publications, bulletin boards, universities, etc., to update their AIDS resource lists to include this new number. Our 800 number is currently valid in the 48 contiguous United States and in Canada. The correct number for local San Francisco calls, for other geographic areas, and for all non- subscription business is 415/255-0588. Help us make sure that our current numbers are listed in appropriate places in your community, and listed accurately. * Medical professionals, libraries, friends. Does your doctor or other health professional, your HMO or medical center, subscribe to AIDS TREATMENT NEWS? What about your local public library, or college or university library, or the human resources department where you work? Do you have friends or loved ones who would benefit from the information in AIDS TREATMENT NEWS? Please use the three coupons on the last page of this issue of the newsletter to encourage others to subscribe. Remember that we support our work almost exclusively through subscriptions; in order to maintain complete editorial independence, we accept no advertising. * Special Assistance Fund. Although we offer a substantial 60 percent discount on subscriptions "for persons with AIDS/HIV with financial difficulties" (and as many as 70 percent of our subscribers use that rate at one time or another), the reality is that many subscribers reach a point at which they can no longer afford even the discounted price. Our policy has always been to extend such subscriptions without charge in order to continue the dissemination of valuable treatment information to persons living with AIDS, struggling community-based organizations, prisoners without resources, health departments in a budget crunch, etc., and we do not want to change that policy. However, the need continues to grow faster than we have been able to generate full-rate subscriptions which subsidize these free extensions. We have established a Special Assistance Fund for those who want to support our "free extension" program. We are asking for donations of $20 (equivalent to one six-month extension) and $40 (equivalent to one 12-month extension or two six-month extensions), or multiples thereof. We will track this income separately, and make the information about revenue generated for this fund available to any of our subscribers who request it. AIDS TREATMENT NEWS is not a 501(c)(3) non-profit organization for which donations are tax-deductible; editor/publisher John S. James operates as a sole proprietor. However, we bring a strong not-for-profit consciousness to our work -- we are working to save lives, not in business to make money -- and we hope that you will support this worthwhile program so we are not forced to change our policy. We would like to take this opportunity to thank all of our subscribers who have sent unsolicited contributions to us in the past. These donations have helped tremendously in allowing AIDS TREATMENT NEWS to continue our "free extension" program to this point. ***** 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 HIV. 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