Subject: ddi; Ribavirin; AZT; New Studies Date: Jun 28 1989 (704 lines) &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& TREATMENT ISSUES -- The GMHC Newsletter of Experimental AIDS Therapies &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& Volume III, Number 4: June 28, 1989 [Footnotes are enclosed in triple quotation marks: ((()))] Contents: [items are separated by "*****" for this display] In Memoriam Dideoxyinosine Notes from Montreal: Ribavirin Notes from Montreal: AZT New Studies In Brief ***** Barry D. Gingell, 1954-1989 On Monday, May 29, Dr. Barry Gingell died of AIDS-related complications. Barry founded Treatment Issues in November 1987 and had been Director of GMHC's Medical Information Program until his health prevented him from working. He had been fighting AIDS for over 4 years. When Barry was first diagnosed, he resolved to fight this mysterious disease with every ounce of his strength. He was one the first people to smuggle ribavirin and isoprinosine into the U. S. from Mexico. He courageously went public with his diag- nosis to draw attention to the reality of having a life- threatening disease with no known treatment. By his actions, Barry vigorously illustrated the philosophy of "self-empowerment" which is crucial in dealing with the disease. He encouraged peo- ple to educate themselves about AIDS and to demand the best health care possible. Barry's extraordinary ability to communicate allowed him to fight AIDS on many turfs: at demonstrations, around FDA confer- ence tables and before Congressional committees. Barry forged an invaluable link between these diverse groups, and tried to get them to work together. As long as he was able, Barry remained accessible to the numerous people who wanted his help and attention. At least half of this office time was spent calming people who called and pro- viding them with up to the minute information on experimental treatments that, in many instances, the caller's doctor had never heard of. He was loathe to accept limitations and found it nearly impossible to turn down requests for his time and assis- tance. Barry inspired admiration in everyone who dealt with him. He is a true hero who has left behind a rich legacy of advocates who will continue his work until we have reliable treatments for this disease. When that day arrives, we will remember Barry Gingell with gratitude and pride. ***** Dideoxyinosine (ddI) David Roche Dideoxyinosine (ddI) is one of the most promising HIV antiviral drugs currently in clinical testing. Positive results from several Phase I trials indicate that ddI is active against HIV in human beings. Despite this good news, it is still not clear when Phase II testing of ddI will begin, and even less cer- tain when it will be made available to the many individuals who may benefit from it. Delays in testing and distribution of potential AIDS drugs are common and always frustrating, but in the case of very promising substances like ddI, such problems are particularly distressing. Background ddI and AZT are both members of a family of drugs called nucleoside analogues. A number of drugs in this category have shown the ability in vitro to significantly suppress the infec- tivity of HIV (((Ahluwalia, G., et al., Initial Studies in the Cellular Pharacology of 2',3' - dideoxynosine, Biochem Pharacol 36 [22]: 3797-800, 11/15/87))), presumably through a process known as premature viral DNA chain termination. By blocking the activity of the enzyme reverse transcriptase, these nucleoside analogues prevent the virus from copying its genetic material, a critical step in the process of viral replication. Interfering with viral replication does not involve eradication existing infected cells from the body and should not be thought of as a way of curing AIDS; however, it is a potential means of stemming the process of infection by protecting uninfected cells from HIV, thus prolonging life. The discovery that AZT is effective in human beings led researchers to launch clinical trials of several other nucleoside analogues such as ddI in the hope of finding one or more that might be less toxic or more potent against HIV. In the case of ddI, while in vitro studies showed the drug to be less potent than AZT against HIV, there were also indications it might be many times less toxic when administered to human beings (AIDS/HIV Experimental Treatment Directory, American Foundation for AIDS Research, p.68, Dec 1988))), permitting more of the drug to be taken without significant side effects. Thus, despite the fact that, gram for gram, ddI is less active than AZT, there is hope that is may actually turn out to be a more useful drug overall. Clinical Trials ddI has been in Phase I clinical trials since July, 1988, when a small group of PWAs (currently up to 26) was enrolled in a National Cancer Institute -sponsored trial. Since that time, two additional Phase I trials have been initiated -- one in Sep- tember 1988, at NYU Medical Center and the University of Roches- ter Medical Center, and another at Boston City Hospital. These trials are all dose escalating studies, meaning that groups of 3-6 patients are given ddI at increasingly high dose until what is known as the "maximum tolerated dose" is determined. The NYU trial had reached the ninth dose level as of the time of this writing, which is between 1-2 gm daily. Investigators report that the may have reached the maximum tolerated dose, and that some toxicity has been observed. ddI results presented in Montreal were encouraging across the board. The NCI study revealed anti-HIV effects (increases in T4 cells and reductions in p24 antigen levels) in all but the lowest dose group, with most impressive and sustainable results at the four highest dose levels. All 7 patients in the trial with detectable p24 antigen had lower levels by the second week of treatment. Patients experienced increase energy and gained an average of over four pounds while in the trial (Fifth Interna- tional AIDS Conference, Montreal, Abstract # ThBO. 4,1989))). Similarly, the Boston study, with IV doses ranging from .8 mg/kg/day to 10.2 mg/kg/day and oral doses of twice these, yielded increases in T4 cells and reductions in p24 antigen lev- els. In 2 patients, hairy leukoplakia cleared up ((( ibid. TBP. 297))). The NY/Rochester trial had less dramatic results than the other two (only 2 of 6 patients followed at least 10 weeks had a rise in T4 cells, for example), but one patient did have a T4 increase from 237 to 513 while in the study (((ibid. MCP. 130))). ddI crosses the blood-brain barrier, which is an important property for an antiviral. When taken orally, ddI is metabolized into various components. The active antiviral component, called ddATP, has an intracellular half-life of up to 24 hours, implying a much less frequent dosing schedule than AZT (the three Phase I trials administered ddI twice a day). To date, some ddI-related toxicity has been observed, but we do not yet know how serious it is. Some increases in uric acid have been reported and the drug must be taken with an antacid, since stomach acids will cause ddI to break down improperly. Also, mild insomnia and headaches have been reported. At higher dose levels, some patients have complained of pain in their feet, raising the possibility that ddI may cause peripheral neuropathy at certain doses. For patients considering personal experimenta- tion with an underground source of the drug, it should be emphasized that the potential for significant toxicity is real. The risk/benefit ratio of ddI is unknown at this point, since clinical experience with the drug is so limited. Preliminary indications in terms of clinical and laboratory parameters are encouraging, but the long term picture is far from evident. Next Steps According to recent conversations with the Phase I research- ers, no Phase II trials were planned until the original trials determined the maximum tolerated dose. While researchers indi- cate that we may have reached that point, a drug testing strategy that delays efficacy trials in the face of promising Phase I antiviral results is ill-conceived and needs to be modified. A better solution would be to immediately begin expanded Phase II testing of ddI at dose levels that have proven safe so far in Phase I trials, as the current Phase I studies continue. A report in Montreal demonstrated in vitro synergism between ddI and d4T, another anti-HIV drug in Phase I trials (((ibid. MCP. 128))). Perhaps it would be prudent to begin a Phase I trial of both together. We have also heard reports that Bristol-Myers, the developer of ddI, is experiencing some problems in arriving at an optimal formulation for ddI and in manufacturing large quantities of the drug, which could obviously have a negative impact upon a Phase II trial. On the other hand, we are pleased that Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has proposed a "parallel-track" approach to clinical drug trials in which drugs like ddI that have proven safe in Phase I trials would be made available to much larger numbers of patients than before while still in clinical testing. We believe it is extremely important that Bristol-Myers work closely with NIAID to ensure this plan is implemented with respect to ddI. We will continue to keep readers informed of developments surrounding further testing and distribution of ddI, and sin- cerely hope that before long all people who could benefit from this very promising antiviral will have access to it. ***** Notes from Montreal: The Fifth International Conference on AIDS Each year, this conference gets more unwieldy. This year, over 12,000 people flooded a conference center that was not equipped to accommodate the throngs and the amount of data presented. More than 5000 posters were exhibited while con- current oral presentations were packed into a dense schedule. Much of the data was duplicative, and delegates had to dig to find the useful bits of new information. However, there was a greater sense of optimism in Montreal than there was last year in Stockholm. A couple of antivirals look very promising and we may finally know enough about a few treatments to discard them. In this issue and next, we will cover the most important developments unveiled in Montreal. Rather than use our usual footnote format, we have referenced the data by listing the abstract number in parentheses. ***** Ribavirin This antiviral was one of the first treatments for AIDS made available through the underground network. For years, it has been smuggled in from Mexico, where it is sold over the counter. In the three years that the U. S. government has financed clinical trials for AIDS drugs, we have not received a definitive answer about whether this drug works against HIV. Compared to the fabled "fast track" that AZT was speeded along, this sauntering approach to a drug in widespread use is unacceptable. The data presented in Montreal on ribavirin was mostly nega- tive. The largest trial conducted to date occurred in Spain. 131 patients were given either placebo or approximately 900 mg (15 mg;kg) ribavirin daily (TBP. 294). After six months, similar percentages of patients in each group had progressed illness (19% and 16% -- since the code has not yet been broken, we don't know which group received drug). This trial will continue for another 6 months. A shorter trial looked at higher doses in 31 patients. Two groups of 8 men were given either 1200 mg or 1600 mg ribavirin daily (ThBO. 1). An additional 15 patients who had been on 800 mg daily for about one year were put on an escalating dose ar m for 20 weeks. Researchers found no antiviral or immunorestorive effect. In fact, patients experienced a drop in T4 counts, which was more pronounced at 1600 mg. Investigators concluded that 1200-1600 mg ribavirin looks ineffective, but there is still a possibility that lower doses (600-800 mg daily) may be useful. A Phase I trial of ribavirin plus isoprinosine yielded equally disappointing results. 15 patients who were asymptomatic or had PGL and T4 counts between 150-400 were randomized to 1200 mg daily or 800 mg for 5 days, then 1200 mg daily (ThBO. 2). All participants were given 4 gm isoprinosine daily as well, and were treated for at least 2 months. The combination seemed to have suppressive effect on HIV, although it was easier to culture virus after treatment in the group on the lower maintenance dose. 7 patients had a significant drop in T4 cells, and other immune system parameters remained unchanged or worsened. Finally, one study enrolled 24 AIDS and ARC patients in a study looking at 800 mg and 1200 mg daily (TBP. 296). over an average of roughly 3 months treatment, no significant toxicity was noticed. Researchers also report that participants are hav- ing fewer opportunistic infections (a total of 5), but that KS is progressing. p24 levels rose and T4 counts decreased. Overall, the data suggest that ribavirin does not have sig- nificant antiviral effect. While it is possible that a subset of patients in early infection may benefit from lower doses, one researcher aptly observed that if real efficy had been seen with ribavirin, we would know it by now. ***** AZT Stephen Gum, M. D. Zidovudine (AZT) is still the only drug specifically approved for use against HIV. Montreal has given us some addi- tional insight on its usefulness. For a long time we have heard complaints about the validity of the original AZT trials. Yet AZT has been used with success in AIDS patients, apparently improving survival, decreasing numbers of opportunistic infec- tions, and improving quality of life. Effectiveness Compared with historic controls, (i.e. patients not receiv- ing antiviral treatment) AZT apparently prolongs life for patients with HIV infection, but drug toxicity and the progres- sion of immunodeficiency limit survival (WBP. 337). A number of large trials report improved quality of life even with less than full dose (1200 mg daily). Once study of 100 patients with ARC and AIDS found that only 35% were maintained on their initial dose. The other 65% had dose reductions due to toxicity. Those on reduced dose did well. Interestingly, of those who progressed from ARC to AIDS, most were still on their initial (higher) dose (WBP. 364). A chart review of 126 patients showed mean survival to be 333 days before AZT was available, compared to 136 patients who took the drug and survived for an average of 593 days. This clearly shows prolonged survival, but does not prove the cause is AZT (WBP. 345). In another study, 226 symptomatic patients were followed for an average of 38.5 weeks. 3.5% of participants pro- gressed to AIDS, duplicating results of the original placebo con- trolled trial. This percentage is lower than rates obtained from historical controls. For most of this trial (70% of the follow- up period), patients were on reduced dose or off the drug, sug- gesting that a lower dose may be as effective as full dose. In a large Italian study, 272 patients were put on AZT between August 1987 and May 1988. All were treated for at least 30 days. 773 others remained untreated until July, 1988. 90% survived in the treated group after one year versus 44% in the untreated group. The survival pattern of those who discontinued the drug within 30 days was similar to the untreated group. AZT treatment in this clinical setting was associated with increased survival of AIDS patients even when comparison was made with con- temporaneous untreated controls rather than with historical con- trols (MBO. 46) In a chart review of 101 patients with AIDS or ARC on 800 mg AZT followed for an average of 7 months, 77% of the patients sur- vived, although a decreased AZT dose was necessary in 33%. Dr. Margaret Fischl, a prominent AZT researcher at the University of Miami, reported extended data from patients on the original placebo controlled trial. She said that follow-up data on patients treated for up to 30 months showed 20-40% survival which was 2-3 times the survival compared to the untreated group. Dr. Fischl also emphasized the importance of prophylaxis for PCP in the survival statistics. She found that up to 6 months there was not difference in survival between those on AZt alone or with PCP prophylaxis. After 6 months and up to two years there was an improved survival in patients taking both. It is difficult to know to what extent PCP prophylaxis is responsible for longer survival. In terms of dose Dr. Fischl said lower doses and longer intervals between dosing may be effective, and may have reduced toxicity. The data is still preliminary, and long-awaited results of a multicenter trial of half dose therapy should be available by the end of the summer. (TBO. 13) Early Use of AZT Many physicians treat patients with AZT if they are symp- tomatic and have T4 cell counts lower than 200. The use of AZT in asymptomatic patients with higher counts is a subject of great debate. Dr. Fischl remarked in Montreal: "I treat HIV-positive symptomatics no matter what their T4 counts are." However, the optimal time for starting AZT is an unresolved question at this point. One study looking at the benefit of AZT in AIDS patients after a first episode of PCP showed a statistically significant benefit on in the patients who began AZT within 270 days of their PCP episode (WBP. 347). Another study of 66 patients were divided into early and late treatment groups by T4 cell levels. The early treatment group had a mean T4 count of 285. The late treatment group had a mean T4 count of 285. The late treatment groups had a mean T4 level of 97. Researchers found that earlier treatment of HIV infection, before advanced damage to the immune system occurred resulted in improvement of immune system defects, whereas patients who initiated therapy later did not show this improve- ment (TBP. 315). One poster reported on 75 asymptomatics with fewer than 300 T4s (WPB. 355). 36 patients took placebo while 39 were given roughly 1200 mg AZT daily. After one year, 14% of those on drug progress to AIDS, as opposed to 33% of those on placebo. Two years after the study began, however, the percentages leveled off, with roughly 60% of both groups having progressed to AIDS. This study underscores the limits of long term use of AZT. AZT plus Acyclovir In a 12 month study of 56 patients who were asymptomatic or had PGL, patients were randomized to no treatment or 1200 mg AZT a day plus 800 mg acyclovir ("ACV"). No progression to later stages was noted in the treated group, while three of the untreated group progressed to AIDS. p24 antigen, initially undetectable in 11 subjects in both groups, remained undetectable in all the treated subjects, while it became detectable in 2 untreated subjects. In treated subjects with measurable p24 lev- els at entry, a decrease in these levels was noted (WBP. 368). Another study followed 18 symptomatic HIV-positives on AZT (1000-2000 mg) and 6400 mg ACV for 60 weeks. This regimen resulted in lower p24 levels in 23 of 24, but disease progression continued. ACV addition made no obvious difference. Both 250 mg AZT every 6 hours and 500 mg every 12 hours were effective start- ing doses. In one study, 60 symptomatic ARC patients were treated with 1200 or 800 mg AZT with or without 1200 mg ACV for one year. Disease progression was noted in only one patient who was receiv- ing 800 mg AZT. T4 cell counts increased in the treated group. Measurable p24 levels did not appear in the treated group, and in two of the untreated group. HIV infection seemed to progress more slowly in treated patients than in those untreated (WBP. 346). Another smaller study showed similar results (MBP. 349). One exciting study examined 54 patients on 800 mg/AZT, with 800 mg/day ACV for 20-36 weeks. The combination produced clini- cal effects similar to full dose AZT alone, with fewer side effects (WBP. 318). Another study of this combinations showed improvements in p24 antigen levels in asymptomatics (WBP. 321). Finally, in a study of 16 patients, low dose AZT (500 mg/day) with ACV (2-4 gm/day) was well tolerated for 1 year by asymptomatic seropositive. Patients receiving 2 gr ACV had vir- tually no disease progression. Further studies are needed to determine clinical outcomes (MBO. 50). Managing Toxicity The most common serious toxicity of AZT is anemia. There is some potentially exciting news in this area. Erythropoietin (EPO) is now being shown to be effective in reducing the transfu- sion requirements of some patients on AZT therapy (MBO. 48, MBP. 328). The other most common serious toxicity of AZT is neutro- penia, deficiency of certain white blood cells. Some early stu- dies with a drug called GM-CSF, which stimulates production of these white blood cells have shown promising results. One study alternated AZT with GM-CSF. This regimen seemed to decrease the toxicity of full dose AZT (WBP. 329). Another study showed the combination of EPO with GM-CSF to be effective in reversing the anemia and neutropenia associated with AZT, allowing the resump- tion of full dose therapy in AIDS patients. This combined regi- men may be of benefit to AIDS patients who have shown intolerance to AZT in the past (MCP. 52). Dr. Fischl found that AZT-induced anemia is not dose depen- dent. However, the neutropenia may be dose dependent and patients may benefit by dose reduction. Myopathy, or muscle wasting, was seen in 25/89 patients studied (TBO. 13). Symptoms resolved 1-8 weeks after interruption of therapy. Half of the patients developed recurrent symptoms within one week of restart- ing AZT (MBP. 329). Interestingly, one poster suggested that AZT may have improved HIV-related myopathy (MBP. 330). Other toxici- ties noted were confusion, seizures, acute encephalopathy, and hepatitis (TBO. 13). Temporary discontinuation of AZT has been used as a way of reducing anemia and neutropenia. One study of 72 patients looked at the "washout" period after ending AZT therapy. The study sug- gested that discontinuation of six weeks or greater actually increases viral reproduction compared to taking no AZT at all. Researchers suggested further studies, but also recommended a shorter washout period (WBP. 351) Summary While the therapeutic benefits of AZT have been extensively proven, we still do not know the optimal dose or when it is most beneficial to start using the drug. Delegates were disappointed once again to find that results of large NIH studies looking at reduced dose AZT are still not available. Several studies demon- strate in vivo synergism between AZT and ACV, which may allow patients to take less AZT. Also, certain treatments have been shown to counter AZT's toxicity. Treatment Issues will report results of studies examining early use of AZT and lower doses as soon as they are available. ***** New Studies Beth Israel Medical Center is recruiting for a Phase II AL 721 study for patients with ARC or PGL. Participants must have more than 200 T4 cells and be p24 antigen positive. The trial will assess the antiviral effect of AL721. Results to date with this drug have been disappointing, but no large study has been able to convincingly demonstrate whether the drug works or not. Hopefully, this trial will provide some concrete answers. Beth Israel is also conducting a Phase I (safety) study of low-dose AZT plus alpha-Interferon. Patients must be symp- tomatic, have more than 200 T4 cells and be p24 antigen positive. Patients with an AIDS diagnosis are not eligible for the study. Alpha Interferon has been approved to treat Karposi's sarcoma; in this study, researchers will examine its anti-HIV activity. For more information about either of these studies, call Beth israel Clinical Trials program at (212) 420-4519 Fenway Community Health Center, in Boston, is recruiting for a Phase I trial of Peptide-T. Data released in Montreal sug- gested that this drug, which crosses the blood-brain barrier, may be more effect than AZT in treating neuropsychological effects of AIDS. The Center will be recruiting 70 HIV-positive symptomatic individuals for a six month study. The drug will be administered intranasally (inhaled). No other concurrent antiviral medication will be allowed. For more information, call Ken Trask or Jane Kaatz at (617) 267-7573. ***** In Brief Erythropoietin: Ortho Pharmaceutical was recently awarded a Treatment IND for this drug, which allows the company to make it available to certain patients before it is fully licensed. Erythropoietin (EPO) stimulates production of red blood cells. Now, PWAs who are anemic will have access to the drug at no cost. To qualify, patients must be anemic, with a hematocrit level of less than 30 and low natural levels of EPO (under 500 mu/ml). Recipients will be examined regularly, so that researchers can collect data to support full licensing of the drug for HIV- related anemia. EPO was fully licensed recently for kidney disease patients who are anemic, so patients who are anemic due to other causes will probably have trouble being reimbursed for the expensive drug. Ortho Pharmaceutical has generously elim- inated the financial obstacle to anemic PWAs. For information about how to obtain EPO through the Treatment IND program, call 201-218-6136. A comprehensive article on this important drug appeared in Treatment Issues, Vol. III, No. 2. PCP Prophylaxis: The Food and Drug Administration announced final licensing approval for aerosolized pentamidine, a drug that prevents PCP. Lyphomed, a pharmaceutical company in Illinois, was awarded exclusive rights under the Orphan Drug Act to market the drug. A second pharmaceutical company, Fisons, has also applied for a license to sell aerosolized pentamidine, using a different nebulizer (the machine used to take the drug) and a much lower dose. Their application is being seriously considered by the FDA. This is good news for PWAs; competition will allow patients more choice in terms of equipment and dose and should lower the price of the drug. The amount of pentamidine necessary to prevent PCP may vary dramatically from patient to patient depend- ing on immune system status. Another noteworthy development is the publication of a comprehensive article on guidelines for PCP prophylaxis, printed in Morbidity and Mortality Weekly Report, an influential medical periodical published by the Centers for Disease Control. the article appeared in the June 16, 1989 issue. Overall, the piece is excellent, but, unfortunately deficient in its coverage of Dapsone, another drug that is useful in preventing PCP. The advantages of Dapsone are significant: it is taken orally, has a low sulfa content (as opposed to Bactrim, which many PWAs can't tolerate due to sulfa allergy), the cost is minimal and it helps prevent pneumocystis outside of the lungs. Ansamycin: This experimental drug has been available for a number of years through a "Compassionate Use" protocol to treat MAI infections. No clear treatment regimen exists for MAI, which is being seen more and more in PWAs. Usually, a combination of 5 or 6 drugs is used together in an attempt to control the infec- tion. Now, FDA has indicated to Adria, the pharmaceutical company developing Ansamycin, that it must conduct controlled clinical trials before the drug will licensed. At this point, no provi- sion is being made for patients with newly diagnosed cases of MAI to gain access to the drug. Due to the uncertainty of how to clinically manage MAI and the frequent treatment failures seen with this infection, it is unconscionable that a potentially use- ful drug is now out of physicians' reach. One study of 17 patients with MAI, presented in Montreal (abstract #ThBP. 54) reported that all strains of MAI seen in the study were suscepti- ble to Ansamycin (which is also known as Rifabutin). This case of restricted drug access recalls the fiasco that resulted when FDA tried to limit availability of Ganciclovir to patients with CMV retinitis, a position recently reversed with the full licens- ing of Ganciclovir. American Preferred Plan is a mail order pharmaceutical com- pany that is offering some important incentives. The company claims to provide "zero cost" prescriptions: clients do not have to pay up front for drugs. APP bills private insurance and Medi- caid directly, and will accept 80% payment. This system should drastically relieve the cash flow shortage that is common among PWAs relying on reimbursement. Company representatives have assured us that lists are kept strictly confidential. For more information, call 1-800-445-4519 in New York state, and 1-800- 227-1195 outside of New York. The AIDS Treatment Registry is up and running. This community-based organization is committed to compiling up-to-date information on clinical trials in New York and New Jersey, and invaluable service to PWAs in these states. Their easily read- able guide publishes information on clinical trials of antivirals, immunomodulators, drugs for opportunistic infections and treatments for HIV-related cancers. These is a special sec- tion on trials for children. The guide lists inclusion/exclusion criteria, study cites, contact names and telephone numbers. There is also a handy glossary at the end. To order a directory, call (212) 268-4196. Other Resources American Foundation for AIDS Research (AmFAR) regularly updates their catalog of trials involving experimental drugs. The "AIDS/HIV Experimental Treatment Directory" also includes several glossaries and information about the federal clinical trials efforts and licensing of drugs. Write to AMFAR at 1515 Broadway, Suite 3601, New York, NY 10036, or call (212) 719-0033. "AIDS Treatment News is a short, biweekly report which chronicles current developments in experimental and alternative treatments and deals with public policy issues. Contact John S. James at P. O. Box 411256, San Francisco CA 94141 or call (415) 255-0588. "PWA Coalition Newsline," published "by and for people with AIDS and AIDS Related Conditions," is a grass-roots news magazine that appears monthly. The publication reports news developments dealing with the health crisis as well as alternative treatments. Editorials and literary contributions add another interesting dimension to this excellent source of information. Write PWA Coalition Inc., 31 West 26th St., New York, N. Y. 10010, or call (212) 532-0290. Ask about their other publication, "Surviving and Thriving with AIDS." The Universal Fellowship of Metropolitan Community Churches publishes a monthly newsletter called "Alert," covering AIDS related legislation, education, research and treatment. Write to Rev. Steve Pieters, UFMCC, 5300 Santa Monica Blvd., Suite 304, Los Angeles, CA 90029. "ATIN" (AIDS Targeted Information Newsletter) preforms a monthly search of hundreds of medical journals worldwide. Defin- itely aimed at doctors and researchers, it is the best ongoing literature search available. It has an impressive cast of edi- tors who comment on the significance of the studies cited. Pub- lished by Williams & Wilkins, P. O. Box 23291, Baltimore MD 21203 or phone 1-800-822-7422. Project Inform publishes an excellent newsletter called "PI Perspective" which deals with experimental treatments and focuses special attention on drug regulatory issues and public policy. Another valuable resource is their up-to-date drug hotline. Call them at 1-800-822-7422. Body Positive is an organization established by and for HIV- antibody-positive people to exchange information, advocate research, fight discrimination, and provide mutual emotional support. They publish a monthly newsletter called "The Body Positive." Write to 208 West 13th St., New York, N. Y. 10011 or call (212) 633-1782. Northern Lights Alternatives (NLA) is an organization that was created to help PWAs channel their energy in positive, heal- ing directions. The cornerstone of NLA is a program of weekend retreats called AIDS Mastery Workshops. The main goal of these workshops is to teach NLA's central philosophy: PWAs can improve the quality of their lives through self-empowerment. NLA disseminates material through the telecommunications network of GayCom. Anyone with a personal computer and modem can access this service. NLA Online has launched, as of September 1987, and AIDS Bibliographic and Abstract Service (ABAS). This database gathers together of 2000 medical articles from a variety of sources. For more information on NLA Online and ABAS, contact Quique Palidino at 212-337-8747. For more information about NLA in general and the AIDS Mastery Workshops, contact Jack Godby at 212-877-4846. "Healing AIDS" is a monthly magazine which focuses on holis- tic approaches to AIDS and ARC including diet and nutrition, relaxation and visualization techniques, and stress reduction. It regularly lists other resources. Subscriptions are $10/year for people with AIDS/ARC/low income, and $15 for others. Write: 3835 20th Street, San Francisco CA 94114 or Phone: (415) 821- 7646. The AIDS Health Project at the University of California San Francisco publishes a monthly newsletter called "Focus" written "to place data and medical reports in a context that is meaning- ful and useful to its readers." It provides easy-to-understand practical information on AIDS research. Contact UCSF AIDS Health Project, Box 0884 San Francisco CA 94143 or phone (415) 476-6430. ***** Treatment Issues is GMHC's newsletter devoted to providing reliable information on experimental AIDS therapies. Describing an experimental therapy should not be construed as recommending it. All new treatments should be done under a physician's care. Treatment Issues is published ten times yearly. Copyright 1989 Gay Men's Health Crisis, Inc. All rights reserved. Non- commercial reproduction is encouraged. Subscription list is kept confidential. Editor: Kevin Armington Technical Assistance: Howard Welsh We Need Your Support Your contribution will help GMHC to continue Treatment Issues and is tax-deductible. Mail to GMHC, Department of Medical Informa- tion, 129 West 20th St., New York NY 10011. A $20/year donation is suggested for a yearly subscription ($40/year foreign). All back issues are available for a suggested $10 donation. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& End of display