The newest HIV drug on the market combines three Glaxo Wellcome HIV nucleoside analogs in one tablet (how financially convenient). Trizivir consists of Retrovir (AZT), Epivir and Ziagen. There's still a debate over whether the three-in-one powerful drug works well in people with more than 100,000 viral load. What is known is that the drug has held its own against a triple combination with a protease inhibitor (Combivir -- which is made up of Retrovir and Epivir -- along with Crixivan) for people taking HIV drugs for the first time. Not bad. It also saves protease inhibitors and non-nucleoside analogs (like Sustiva and Viramune) for later if needed. The price is approximately $10,800 a year, or the cost of the three drugs combined. See the drug guide in this issue for more information on the meds in Trizivir.
The hepatotoxicity (liver damaging) warning on Viramune has been strengthened to suggest close monitoring of liver function tests during the first 12 weeks of use, when two-thirds of severe liver problems seen occur. How often tests should be done is not known, but getting your levels before you go on Viramune is a good idea, in order to determine if your numbers go up significantly. People who start out with high AST or ALT (liver function levels) or who have hepatitis B or C are at greater risk of further liver problems. The label also reminds everyone that dose escalation is important. Why anyone has to be reminded of how important this is, especially doctors, is a testament to the widespread ignorance that continues to kill people. Read this issue's drug guide -- please.
People with HIV who take protease inhibitors have a greater risk of lesions in their carotid vessels than those who are not on PIs. These two main arteries run through the neck. Heart troubles, including heart attacks and strokes, have been seen in people on HIV therapy, perhaps out of proportion to the risk seen by people not on therapy. Italian researchers looked at 102 people with HIV, 55 of who took protease inhibitors. Men, older people and people with high cholesterol levels had a greater risk of the lesions, as well. But smoking, high triglyercide levels and advanced disease increased risk even more, although not as much as use of PIs. The findings were reported in the November 10 issue of AIDS.
The U.S. Public Health Service and the Centers for Disease Control and Prevention issued revised guidelines urging all pregnant women to test for HIV. However, testing should be voluntary. Healthcare providers are urged to explore reasons for refusing an HIV test and to offer testing again during delivery for women who have not been tested. So many women who believe they're "not at risk" learn that they are HIV positive only after giving birth. Now it's fairly easy to prevent the transmission of HIV to a newborn, including at the time of delivery. It would be a shame for infants to continue to be needlessly infected because of a perceived lack of risk that was never put to the test. For a copy of the guidelines, call the CDC National AIDS Hotline at 1 (800) CDC-INFO (now 24 hours) or visit www.cdc.gov/hiv/frn/perinatal.pdf.
In the last several years, ACT UP Philadelphia has been the most powerful of the few surviving chapters around the country. With the New York City chapter, Philly gained price reductions on a new HIV drug and organized the march for drug treatment access in South Africa during the international AIDS conference last July. They followed the presidential candidate Al Gore around the country, demanding that the U.S. allow third world countries to manufacture generic versions of HIV drugs. All of this depletes the money they manage to scavenge together, not to mention their round-the-clock time. Now, they're being dealt heavy blows by the powers that be. Instead of casual arrests during last summer's Republican Party Convention protests in Philadelphia, ACT UP Philly members along with other activists were kicked, beaten, hog-tied and had their heads slammed into a wall by police officers. They were levied extremely high bonds, including one for one million dollars. Please help the legal defense by sending contributions. The City of Philadelphia is refusing all plea bargaining. Show the authorities that freedom fighters will never be forsaken. Send donations and make checks out to: ACT UP Philadelphia, P.O. Box 22439, Land Title Station, Philadelphia, PA 19110-2439.
The U.S. Department of Health and Human Services has begun contacting eligible families that will receive payments from the Ricky Ray Hemophilia Relief Fund.
As of August 28, more than 4,300 petitions were received since July 31, the first postmark day that petitions were accepted. Approximately 670 recipients will receive compensation with fiscal year 2000 funds, but an estimated 7,500 individuals are eligible to receive funds. The Ricky Ray Hemophilia Relief Fund was authorized in 1998 to provide compensation payments of $100,000 to individuals with blood-clotting disorders, such as hemophilia, who contracted HIV from contaminated anti-hemophilic blood products between July 1, 1982 and Dec. 31, 1987. Spouses and children who contracted HIV from these individuals and certain survivors may also be eligible. For more information, call toll-free at 1 (888) 496-0338 or visit www.hrsa.gov/bhpr/rickyray.
The PhenoSense HIV resistance test can now more closely tell you whether you have resistance to Kaletra or Ziagen. If your blood gets thrown into a test tube and Kaletra is dropped in, but it takes 10 times the normal dose of Kaletra to fight your virus, that's when you know the drug isn't working for you. For Ziagen, however, it only takes 4.5 times the amount of the normal dose to figure out that your virus is resistant (it resists the drug -- successfully fights it off). The manufacturer plans to continue this process with the other HIV meds. Resistance tests are becoming increasingly important in HIV therapy, but are still widely confusing and not FDA-approved.
The Los Angeles County Department of Health Services reported sending HIV prevention messages through anonymous individuals via internet chatrooms. Earlier the department had learned of a syphilis outbreak among men who have sex with men and transgender people who participate in one of its HIV prevention programs. Half of the individuals have HIV, and the group reported high rates of anonymous sex.
The Baltimore Sun reported that a breast cancer fundraiser drew 25,000 participants and raised $1.2 million, while the city's annual AIDS Walk attracted only 2,000 walkers and raised a little over $176,000. Organizers of the AIDS Walk suggested that breast cancer affected more people, of all races and classes, while AIDS has become a disease of primarily poor and black people. In 1999, 82% of HIV positive people in Maryland were African American. AIDS Walk funding is down in Chicago and Los Angeles, but remain strong in New York City and San Francisco.
The San Mateo County Health Center in northern California will provide marijuana to 60 people with HIV who have neurological problems under a study approved (miraculously) by the Drug Enforcement Administration. To date, government efforts to study the drug's medicinal use have been cruelly, and unnecessarily, slow.
A five-year extension of the Ryan White CARE Act unanimously passed both houses of Congress and has been signed into law by President Clinton. While the reauthorization keeps most provisions of the CARE act intact, some changes have occurred. The most significant of these include: expanding funding to medium-sized cities and rural areas, as well as a small number of ADAPs (AIDS Drug Assistance Programs); puts in place assurances that medical care provided under the act conforms to quality of care standards; and tries to assure that people receiving services under the act have access to appropriate medical care by encouraging agencies receiving funding to either offer the care themselves or establish linkages and referrals to medical care. Also included in the bill are some financial incentives to states to adopt some form of testing of all newborn infants, though it is not mandated. Overall, the bill that passed was one supported by HIV activists and service providers. This is an enormous victory for people living with HIV in that when this process started two years ago there was a sense among many in Congress (and the general public) that AIDS was over. Some credit for passage of this vital legislation goes to TPAN members and readers of Positively Aware for their efforts to help members of Congress understand the importance of this bill. Thank you to all of you who wrote or called your Senators and Representatives. -- Dennis Hartke