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Fatigue and AnemiaFatigue and Anemia
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Anemia treatment and possible cure for AIDS
Jul 25, 2002

Hey Dr. Handsome, Congratulations on your AIDS Hero Award -- saw it in the papers. So where is the picture of you in a speedo or perhaps wearing only your Hero Award? Now that's what we's really like to see one of these days. Regarding anemia, you were right my hemaglobin was low and my doctors wasn't really paying much attention yo it because in his words "it wasn't all that bad". Sure that's easy for him to say. I felt like I was only existing from one coffe shop to the next to have enough energy to get through the day. So he's agreed to start me on that injectable stuff but he say's I need to use it 3 times per week because that's what his prescription book says. I'm pretty sure you said it could be used once a week -- right? or am I spacing out again. Secondly did you hear any news in Barcelona about TRAIL? Is it the cure we are all waiting for? Thanks Dr. Bob for just being the great guy that you are and keeping ti real for all of us. You the MAN! Barbery Lane Resident

Response from Dr. Frascino

Dear Barbary Lane Resident,

Now exactly which character from Armisted Maupin's famous books are you? Now let's see, probably not Maryann Singleton, because she would be too shy to request seeing me wearing just my AIDS Hero Award? Maybe you are Mrs. Madrigal? No, she's probably too stoned to be up on recent immune-based therapies like TRAIL. I guess you are Michael, my personal favorite, as he and I had many similar adventures of living in San Francisco in the 70s!

Glad to hear your physician is now "agreed" to treat your anemia. A recent study continues to reveal the majority of AIDS-treating physicians still tend to view fatigue, a primary marker for anemia, as one of the least significant consequences of HIV infection and its treatment. This continues to amaze me, given the importance those of us living with HIV place on the symptoms of anemia. Added to this is the fact that we have excellent treatments available that have been demonstrated to be both safe and efficacious. Correction of anemia, even mild to moderate anemia in the setting of HIV disease or cancer has been shown to improve both the functional capacity (ability to do daily chores) and quality of life! In addition, correction of anemia has been associated with increased survival. OK, the "injectable stuff" is called Procrit. It's identical to a substance your body produces naturally called "erythropoietin." Erythropoietin stimulates red blood cell production. Bottom line if you're anemic: More red blood cells means more energy! Procrit is not appropriate for everyone, and should not be used to treat anemia caused by bleeding, iron deficiency, or weakened red blood cell membranes. However, if your anemia is caused by AZT or by HIV (anemia of chronic disease), then Procrit is your best option. Originally, it was suggested that a 3-times-per-week regimen be used. More recently, clinical trials have clearly demonstrated that the once-per-week dosing regimen is just as effective and obviously more convenient. I reviewed a poster on this subject at the recent World AIDS Meeting in Barcelona. You can see it on The Body's conference coverage pages. It is poster ThPeB781 presented on Thursday, July 11. So Michael (I'll just call you that, OK?), you were not spacing, you are absolutely right on target! The starting dose of Procrit should be 40,000 units once-per-week. If your doctor puts up a fuss, have him call the folks at Ortho Biotech, the company that makes Procrit, or check this web site for information, or he can call me if you think that would help.

OK, second question - first off, it's TRAIL, not TRIAL. Here's what I know. TRAIL stands for Tumor Necrosis Factor-Related Apoptosis Inducing Ligand. There is an article in the Journal of Virology from 2001, "Induction of cell death in HIV-infected macrophages and resting memory CD4 T-cells by TRAIL/Apo 21." This is exciting stuff, but the research is still very preliminary. We don't know, for instance, if this compound can penetrate into sites protected by the immune system (called sanctuary sites), which, of course, would be essential to any hope of actually eliminating the virus from its many reservoirs. Apparently, Immunex (now Amgen) and Genentech are both involved in developing and testing this compound. I did not personally see or hear any information on TRAIL in Barcelona. That doesn't mean nothing was there, but rather just that I didn't see anything related to this particular topic. There were 15,000 of us in Barcelona and many scientific sessions were being held concurrently. I still have not finished reviewing all of the abstracts from the meetings. As you can imagine, trying to wade through 1000s of presentations packed with scientific mumbo-jumbo can (and often does) work like a potent sleeping pill! Continue to review The Body's conference coverage for further details on this and other promising new therapies. Will it be the cure? It's far too early to tell. As you probably know, a great many compounds and drugs look great initially and then are found to be not as safe or efficacious as originally thought. But that doesn't mean the next one won't be the one we are all waiting for.

OK Michael, I hope that helps. Stay well and please do send my very best to all the folks on Barbary Lane.

Dr. Bob

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