Continuity ... and Change

For the last four years we have distributed HIV Newsline, free of charge, to virtually every clinician in this country who treats patients with HIV infection. For the last two years those care providers have also received AIDS Care, again at no charge. We have undertaken this educational effort in furtherance of the editorial credo that Dr. Paul A. Volberding, the editor-in-chief of HIV Newsline, articulated in our inaugural issue: "Our mission is a simple one: to provide clinicians with pertinent, up-to-the-minute information on the diagnosis and long-term management of one of the most complex disease entities every confronted by healthcare providers."

Little did we know, at the time we launched HIV Newsline in early 1995, just how complex the diagnosis and treatment of HIV infection would prove to be. Few diseases present comparable clinical challenges, and few fields have evolved as rapidly. We launched HIV Newsline at the same time that Bristol-Myers Squibb was launching d4T, which was the fourth drug -- all of them nucleoside analogs -- approved to treat people with HIV infection. Four encouraging, eventful years later, there are some two dozen antiretroviral agents approved or in development.

Over the past four years our readers -- who now number more than 22,400, roughly one-fifth of whom specifically asked to have their names added to our mailing list -- have come to count on us to keep them apprised of recent advances in the diagnosis and treatment of seropositive patients. We provide that information by covering major medical meetings and international conferences, by summarizing clinically relevant reports in the literature, and by soliciting editorials, articles, and commentaries from recognized experts in the treatment of HIV disease. As regular readers of our publications know, we do more that relay information: we interpret the data, provide guidelines for prophylaxis and treatment, and assess the merits -- and drawbacks -- of specific drug regimens.

As our reputation has grown, so has our mailing list -- which now includes physicians in 31 foreign countries. With one exception, those clinicians have received their bimonthly copies of HIV Newsline and AIDS Care by air mail, to ensure that the timely information in each new issue does not grow stale in transit. The one exception is a clinician in Sarajevo. Because the postal service in his war-ravaged country is haphazard and unreliable, we send him each new issue over the Internet -- by downloading files as we go to press and e-mailing them directly to him.

Because the treatment community has responded so positively to the pertinent, practical information we have provided in issue after issue -- and because we have filled every subscription request we have received -- our subscription base has doubled over the past four years. During that same period the size of our publication also doubled. As a result, our production and distribution costs have more than doubled since 1995. To help us meet these increased costs, we must ask you to pay a modest annual subscription fee to receive all future issues of HIV Newsline. Your contribution will defray a portion of the cost of printing and mailing our publication -- and it will enable us to continue to provide readers like you with the sort of readable, relevant, reliable information on HIV disease that you have come to expect from HIV Newsline.

Henceforth HIV Newsline will incorporate AIDS Care as a special pull-out feature. In our judgment, this new configuration permits us to offer readers comparable editorial content in a more concise and convenient format. We inaugurate this consolidation of AIDS Care into HIV Newsline with the eight-page, full-color pull out and save feature in this issue. It outlines a safe, simple, and sensible way for patients to accustom themselves to the dosing demands of combination antiretroviral therapy -- before they take a single pill.

This unique teaching tool was developed for us by Helen M. Miramontes, who is a nurse-consultant to the Pacific AIDS Education and Training Center at the UCSF School of Nursing. (She is also a member of the President's AIDS Advisory Council and a mainstay of our editorial advisory board.) Recognizing that people with HIV infection find it hard to comply with the rigid routine imposed by multidrug antiretroviral regimens -- especially at the outset -- Ms. Miramontes devised a risk-free way for those individuals to determine how well they will be able to adhere to their assigned dosing schedule before they actually begin therapy. Care providers will find this practice regimen useful for patients who are switching therapies and well as those who are about to begin treatment.

For this dry run, patients "take" jelly beans instead of medications. Ms. Miramontes chose jelly beans for a number of reasons: because they are universally available, because they are capsule-shaped, and because most people like them. The jelly bean exercise is a game, but it is a game with a serious purpose -- and it will be effective as a teaching tool only if patients and providers alike take it seriously. We hope they will, because this simple exercise has proven immensely useful in practice, helping patients adjust to the demands of multidrug therapy even as it identified the doses that patients were most likely to miss.

The AIDS Care insert in this issue also includes an updated version of "Mastering Combination Therapy," a patient aid developed for us by old pros at pill-taking -- some of whom have been on antiretroviral therapy since AZT was introduced more than a decade ago. We have drawn on their collective experience to develop a list of suggestions that will help all seropositive individuals to achieve -- and maintain -- high-level compliance with their assigned drug regimen.

Our ongoing educational efforts would not be possible without the support of the sponsors listed on the masthead page of this issue. The unrestricted educational grants that those sponsors provide allow us to continue to fulfill our original editorial mission, that of providing pertinent, up-to-the-minute information to clinicians and other healthcare providers who treat people with HIV infection.