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AIDS Treatment News
May 3, 1996

Contents:

Saquinavir: Combination Shows 
Survival Benefit;
New Formulation Trial Recruiting

While three protease inhibitors are now approved for treatment of HIV infection, until now only one (Abbott's ritonavir, brand-name Norvir(TM)) had demonstrated in a clinical trial that it can reduce disease progression and increase survival of patients. On May 7, as this newsletter went to press, Hoffmann-La Roche released survival analysis of a major clinical trial comparing its protease inhibitor saquinavir (INVIRASE(TM)) plus ddC (Hivid(R)) vs. saquinavir alone vs. ddC alone. The combination showed a substantial survival benefit, with 28 deaths on ddC alone and 34 on saquinavir alone, but only 9 on the combination treatment -- a two-thirds reduction in deaths.

The two groups were also compared on disease progression -- defined as the number of persons who either died or had their first AIDS-defining event. There were 85 such progressions on ddC, 77 on saquinavir, and 46 on the combination. An analysis of time to event (not just number of events) showed a reduction of disease progression risk of slightly over one half with the combination, compared to ddC alone.

In both cases, the improvement of the combination vs. ddC alone was highly statistically significant, in this intent-to-treat analysis.

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The trial volunteers had baseline CD4 counts between 50 and 300, and had at least 16 weeks of prior treatment with AZT. The treatment arms were balanced with respect to sex, age, race, baseline viral load, baseline CD4 count, and reason for discontinuing AZT; however, there had been less prior AZT therapy (68 weeks) in the combination group than in the other groups (74-75 weeks).

Discontinuation for toxicity was highest in the ddC arm. The combination did not seem to increase ddC toxicity.

Comment

It is encouraging that a second protease inhibitor has now proven that it can increase survival (when used in combination). The data above indicate that saquinavir did not work well alone. Probably this is because the approved dose is too low; but even with a better dose, or with any other protease inhibitor, use in combination with other antiretrovirals will probably be strongly preferred.

The reason ddC was chosen for use in this saquinavir trial is that the two drugs are marketed by the same company -- and also because this trial began recruiting in February 1994, when ddC was a reasonable choice. ddC need not be chosen today for combination use with saquinavir.

Our impression is that saquinavir (in its new formulation, which delivers a higher blood level -- or possibly in combination with ritonavir, if it is found possible to combine these drugs safely) will work much better than the currently approved dose and formulation, and become an important drug; but the research is not yet available on how to use it optimally. ddC, however, will be much less important in the future, because of its relatively small benefit vs. relatively high toxicity, although it can still be useful for some patients in some combinations.

New Saquinavir Trial

A trial of the new formulation of saquinavir (the soft gelatin capsule, which is more bioavailable than the currently approved drug) is now enrolling in 40 sites across the U.S. Although 400 volunteers were needed, about half enrolled in the first 10 days.

Volunteers must be at least 13 years old, and at least three quarters of those enrolled must not have used any protease inhibitor before. Any CD4 count may be allowed, but only 100 of the 400 volunteers can have counts of 100 or less.

All volunteers will receive the same dose of the new formulation of saquinavir for at least one year. Volunteers are allowed to use other antivirals during this trial, but not other protease inhibitors until safety information is available.

For more information, or to contact a site near you, call the AIDS Clinical Trials Information Service, 800/TRIALS-A.


Improved HIV Survival 
Indicates Effect of Therapy

by John S. James
On May 1, Johns Hopkins researchers published an epidemiological study of survival of persons who were HIV-positive but did not have any AIDS-defining conditions.(1) They found a significant increase in survival between the years before and the years after widespread availability of pneumocystis prophylaxis and antiviral monotherapy. Because this study compared the time periods of 1985-1988 with 1989-1993, it could only record effects of therapies in wide use in the years between 1989 and 1993 -- ignoring effects of more modern strategies like protease inhibitors, widespread combination antiretrovirals, and viral load tests. (Recent data could not be compared, since several years must elapse to provide accurate estimates of length of survival.)

For those without an AIDS-defining condition and without symptoms of AIDS but with a CD4 (T-helper) count between zero and 100, 2.5- year survival increased from 22% to 54% between the period 1985- 1988 to 1989-1993. For those with a CD4 count of 101-200, survival increased from 53% to 71% between those two periods. For those with CD4 in the range of 201-350, the same 2.5-year survival increased from 83% to 91%.

For those with a CD4 count of over 350, the overall three-year survival rate was 94% or greater, and there were too few deaths to see if there was a difference from the earlier to the later period. However, those with CD4 counts over 350 who reported having certain AIDS-related symptoms (less than required for an AIDS diagnosis) had a 1.6 to 2.3 times higher relative hazard of dying than those who had had no such symptoms. (The presence of symptoms had a greater effect on relative hazard at higher CD4 counts than at lower counts, "indicating that the presence of clinical symptoms in the absence of AIDS was a stronger predictor among those with less compromised immune systems.")

This study could not compare the changing risk between the calendar periods for those who started with an AIDS diagnosis, because the data used came from the MACS study (Multicenter AIDS Cohort Study), which enrolled 4,954 gay men in four U.S. cities (both HIV- positive and HIV-negative) in 1984-1985. The MACS entry criteria excluded those who already had AIDS; therefore, the small number who had developed AIDS by the period of 1985-1988 would not have been representative. This study did find that the presence of AIDS (by the old definition, which required at least one opportunistic infection or condition) increased the risk of death by about two to six times, compared to those with the same CD4 count but without AIDS and without other symptoms; however, the data available did not allow accurate estimation of this increase in risk.

This study has limitations. For example, the researchers indicated that there were differences between the earlier and later cohorts which may not have been completely adjusted for by the statistical methods used; therefore, certain biases may have accounted for some of the survival differences. Also, while the two calendar-year cohorts were selected to show a before-therapy to after-therapy change, not everybody in the later group used treatment, and some in the earlier group did, suggesting the possibility that the improved survival due to the treatments available in 1989-1993 could have been greater than this study indicated.

Comment

While the two cohorts in this study were selected to show differences due to pneumocystis prophylaxis and early antiviral therapy, there have also been many other improvements in medical management, especially as physicians have learned more about how to diagnose and treat patients with opportunistic infections. This improved medical management is harder to attribute to particular calendar years, but it would also have contributed to the survival improvement found in this study.

This study suggests that persons without AIDS and with high CD4 counts should also look at AIDS-related symptoms as a factor in planning therapy; these indicated a worse prognosis, and therefore would seem to argue for a somewhat more aggressive approach to therapy than for asymptomatics. The symptoms recorded in this study were "an unintentional weight loss of at least 4.5 kg since the previous visit [visits were every six months], presence of fatigue for at least two weeks, oral thrush or candidiasis for at least two weeks, persistent fever higher than 37.9 degrees C for at least two weeks, and diarrhea for at least two weeks."

References

1. Enger C, Graham N, Peng Y, and others. Survival from Early, Intermediate, and Late Stages of HIV Infection. JAMA. May 1, 1996; volume 275, number 17, pages 1329-1334.


Kaposi's Sarcoma: 
DaunoXome(R) Approved

DaunoXome, a liposomal form of the cancer chemotherapy drug daunorubicin, was approved by the FDA on April 8, and became available from distributors in the first week of May. It is approved as first-line chemotherapy for patients with advanced HIV-related KS -- and NOT recommended for less than advanced KS. Its main advantage is reduction in certain side effects compared with conventional chemotherapy.

Liposomal drugs are formulations in which the active chemical is enclosed in microscopic globules of fat. This can improve the targeting of certain drugs, causing more to be delivered to the tumor where it is needed, and less to go elsewhere in the body where it can cause side effects. Liposomal drugs tend to target both KS lesions and cancer tumors; the reason why is not known, but it is suspected that the liposomes leak out of defective blood vessels which grow in the lesions or tumors. (DaunoXome is also being tested for various cancers; at this time it is approved only for KS, although physicians can use it "off label" for other purposes.)

DaunoXome, which is being marketed by NeXstar Pharmaceuticals of San Dimas, California, is the second liposomal chemotherapy drug approved; the first, DOXIL(R), which is liposomal doxorubicin (it is named DOX-SL outside the U.S.), was approved in late 1995 (see AIDS Treatment News #236). The two drugs have not been tested head- to-head in a trial, and are not likely to be, so there are no data comparing them. One major difference is that DaunoXome has been approved for first-line use, while DOXIL has been approved for KS patients who have failed standard chemotherapy.

Also, DaunoXome is been priced less than DOXIL; according to NeXstar, its price is comparable to that of standard chemotherapy. This cost advantage is partly offset by the fact that DOXIL is infused once every three weeks, while DaunoXome is infused once every two weeks, increasing the total infusion cost. NeXstar has a patient- assistance program to help in paying for the treatment; for more information (or to enroll), patients, physicians, or social workers can call 800/226-2056.

The major acute toxicity of DaunoXome is bone-marrow suppression -- especially loss of granulocytes (including neutropenia, which can lead to serious or life-threatening infections); blood tests are necessary so that treatment can be interrupted if required.

With the conventional form of daunorubicin, the most serious long- term risk is cumulative heart toxicity. This appears to be much less of a problem with the liposomal form of the drug. But because it is possible, the DaunoXome package insert begins with a prominent warning to monitor for possible heart toxicity -- especially for patients who are at risk, due to previous heart problems or previous use of this class of drug.

Many but not all side effects are less with DaunoXome than with the conventional chemotherapy most likely to be used instead (ABV, which is a combination of Adriamycin (doxorubicin), bleomycin, and vincristine). For example, neuropathy was reduced from 38% to 12%, and hair loss from 36% to 8%, in the major phase III trial which compared DaunoXome to ABV in a total of 227 patients.

Since chemotherapy is not a cure for KS, treatment may need to be continued indefinitely, or for as long as the drug continues to work.


Crixivan(R) Price: 
Behind the Reduction

by John S. James
Our last issue (AIDS Treatment News #245) noted that patients who are paying out of pocket for the Merck protease inhibitor indinavir (Crixivan), which they can only purchase from Stadtlanders Pharmacy, can save $97 per month just by obtaining a discount card from a competing mail-order pharmacy, Community Prescription Service (phone 800/842-0502). The cost of the discount card is $18. Because this price reduction was announced just before our previous issue went to press, we did not have time to explain how it occurred.

For big organizations like insurance companies, HMOs, and government agencies, pharmaceutical prices are like hotel-room prices; almost nobody pays the officially stated price. Instead, each company negotiates a lower price which it pays for the clients it covers. But in pharmaceuticals, unlike hotels, individuals are usually excluded from these price reductions. Therefore, persons who have to buy their drugs out of pocket pay the highest price; organizations pay substantially less. (Some individual pharmacies have sold some drugs at or near cost, as a community service; this does not affect the wholesale price, however.)

In the case of Crixivan, an unusually high markup, plus charging individuals paying out of pocket the highest price while insurance companies and HMOs paid less, led to widespread protest against Stadtlanders. Merck had established an unexpectedly LOW price which it charged wholesalers for this drug, $12 per day. But Stadtlanders, a company well known for service and for supporting the AIDS community, temporarily became both the only wholesaler and the only retailer that individuals could use to buy Crixivan. It charged out-of-pocket customers $16.50 per day -- a wholesale and retail markup together of 37.5%, or over $1600 per year for filling 12 prescription bottles. The high markup plus the highest price for cash customers led to the protests.

In practice, almost all Crixivan sales were at lower prices through insurance plans, as few individuals can pay for their own protease inhibitors. Therefore, the extra profit from the high price to individuals would not make much financial difference to Stadtlanders. But according to Stadtlanders, for legal reasons a pharmacy cannot establish multiple levels of retail pricing (such as a cash discount to individuals). [Comment: If this is true, then Congress needs to be told that its laws are creating an injustice, by allowing discount pricing to every insurance company and HMO, while forbidding similar discounts to unorganized individuals, who have to pay more than any organization when buying drugs out of pocket.]

Stadtlanders found a way out of this situation by agreeing to recognize the discount card of CPS, which was already honored by about 60% of pharmacies in the U.S. This way individuals could get contract prices like those negotiated with insurance companies, HMOs, and government agencies. The official price (for individuals who do not get the card) is still $16.50 -- but no one needs to pay that price any more, and fewer people will pay it. With the card, the cash price is reduced to $13.27, saving patients $97 per month. (Stadtlanders will not accept the CPS card in conjunction with any other drug card or insurance coverage, meaning that individuals with other coverage must pay cash up front if they use the CPS card, and be reimbursed later.)

This reduction would never have happened except for the protests, which were led primarily by several organizations: ACT UP/Golden Gate, ACT UP/New York, ACT UP/Philadelphia, the PWA Coalition of New York, and the PWA Health Group (the largest buyers' club in New York). The protests included substantial publicity, as well as several persons arrested for posting signs on Stadtlanders' New York City outlet. Apparently the fear of a public-relations reversal pressured Stadtlanders into finding a solution, when the hardship to individuals who had to pay the unrealistic official price did not do so. It is widely believed that some other AIDS organizations may not have supported the protest because they had been funded by Stadtlanders, but there is no way to know for sure.

In the long run, what is happening is that individuals are increasingly being pressured to organize into groups, to avoid being at a serious disadvantage because they do not have the negotiating clout that large organizations do. The Stadtlanders events have spurred activists to look into other AIDS-drug pricing issues, and already they are finding remarkably large variations from pharmacy to pharmacy in what individuals have to pay. Often it is quite unexpected who is charging much more, and who much less, for the same drug. Price is not everything, as some companies give better service (which can make the difference between whether or not someone gets a prescription they need), and some pharmacies support community organizations while others do not. But if those patients who must be concerned about price are not advised how big the variations are, and where to find the lowest prices, we have a problem. Activists are now likely to work harder on immediate price issues, publicizing large variations and getting comparison information to patients who need it.

The Crixivan price reduction was a remarkable victory which shows how beneficial activism can be. But there is still concern that the high nominal price could set a precedent for higher distribution costs in the future.


California: 3TC 
Now Available through ADAP

On April 25, lamivudine (3TC) was added to the list of drugs available from California's AIDS Drug Assistance Program. According to the California Department of Health Services, this was made possible by an additional $2.3 million in funds, over $2 million of which was from voluntary rebates on drugs purchased from Glaxo Wellcome Inc., which markets AZT as well as 3TC. The ADAP program in California has been under financial strain, because the number of prescriptions filled increased from 96,000 in the last fiscal year to almost 150,000 this year. Most other states' ADAP programs have similar financial difficulties.

It is considered likely, although not certain, that California's ADAP will be able to pay for 3TC, as well as one or more protease inhibitors, in fiscal year 1996-1997.


Women and HIV: 
Conference Calls May 14, 15, 
on Treatment Concerns

BETA (BULLETIN OF EXPERIMENTAL TREATMENT FOR AIDS), the quarterly AIDS treatment magazine published by the San Francisco AIDS Foundation, is sponsoring free nationwide interactive telephone conference calls on the special treatment concerns of women with HIV/AIDS. The first call will be on Tuesday May 14, and there will be another on May 15; both calls begin at 3:30 p.m. Pacific time (6:30 Eastern time). Callers can listen to and ask questions of a panel of experts. These phone conferences are supported by an educational grant from Hoffmann-La Roche.

To join one of these calls, you need to register in advance, by calling 800/707-BETA.


Alternative Treatments for HIV: 
Nationwide Survey Seeks Users

A well-designed study of complementary and alternative medicine is now recruiting 1500 persons who are using alternative medicine in HIV/AIDS treatment -- regardless of whether or not they are also using conventional medicines in addition. If you are HIV-positive, at least 18, able and willing to give informed consent and independently complete study forms, and a U.S. resident, you are eligible for this study.

Participants will fill out a 25-page questionnaire every six months for at least a year. A small compensation ($10 or $15) will be provided for each completed questionnaire.

About the Study

This survey is using a well-known technique called "outcomes research," to see if the use of certain treatments is associated with better or worse medical outcomes than others. Outcomes research uses repeated health status evaluations in ordinary care settings. This methodology has both advantages and disadvantages vs. randomized controlled trials. Unlike randomized controlled trials, outcomes research does not find a causal relationship, so it cannot provide definitive proof that a treatment is beneficial. But it can identify an association of good or bad results with a particular therapy, producing prospective, systematically collected information which can be helpful for designing trials, as well as for making treatment decisions.

Outcomes research examines medical care as it is actually delivered, avoiding both the ethical concern about randomizing patients to predetermined protocols, and also the difficulty in generalizing from highly selected cohorts and artificial protocols to patients in general practice. But on the other hand, outcomes research does not have the internal validity of randomized controlled trials, and often needs larger numbers of patients to obtain statistically significant results.

This alternative-treatment survey is being conducted by Bastyr University, an accredited multidisciplinary natural medicine university, with funding from the National Institutes of Health Office of Alternative Medicine. The principle investigator is Leanna Standish, N.D., Ph.D., of the Bastyr University AIDS Research Center. The trial was designed primarily by Carlo Calabrese, N.D., M.P.H., who is widely recognized as an expert in outcomes research in alternative medicine. It is the only large-scale study of alternative medicine for the treatment of HIV/AIDS now taking place in the U.S.

For more information, or to volunteer, call 800/475-0135. Physicians and other practitioners who are interested in working with this study can call Project Coordinator Cherie Reeves, 206/517-3578. More information is also available on the World Wide Web, http://www.bastyr.edu/research/recruit.html.


Federal Policy: Ryan White, 
OAR, Testing Newborns

by John S. James
With the recent budget compromise between the White House and Congress (the omnibus budget agreement, which is for fiscal year 1996, which ends in five months), AIDS advocacy groups won four of the five issues on the table in this budget negotiations:
  • Increased funding for the Ryan White CARE Act. The AIDS Drug Assistance Program (which helps individuals with limited incomes pay for certain prescription drugs) received an increase of $52 million, as had been expected. In addition, there was an unexpected increase of $30 million for the Ryan White program overall, due to the work of AIDS advocates and of the White House.
  • Repeal of the HIV military discharge. The budget compromise repeals the law introduced by Congressman Robert Dornan (Republican, California) which would have required the military to discharge over a thousand service men and women with HIV.
  • Saving the AIDS Education and Training Centers. This program will be cut, but not eliminated, as had been feared.
  • Saving Housing Opportunities for People with AIDS (HOPWA). This program is flat funded (neither increased nor decreased) for fiscal 1996 -- which is better than had been expected.

Negotiations for fiscal 1997 (which begins October 1, 1996) are already well underway. It is important that the concerned public understands the outline of the major AIDS issues involved, so that we can provide grassroots support for our lobbying organizations when necessary.

The OAR Budget Issue

The issue which AIDS groups lost in the budget negotiation was the consolidated budget authority for the OAR (Office of AIDS Research) -- authority which the OAR has had for more than two years. Almost all AIDS organizations involved in this issue strongly support letting the OAR keep this authority, and will be pushing hard to restore it for fiscal 1997.

A central argument for OAR budget authority is that while other major diseases have their own Institutes at the National Institutes of Health (e.g., the National Cancer Institute), a separate AIDS Institute is not possible right now, and might not be best anyway, because AIDS is related to so many branches of medicine that AIDS research can best take place within the other Institutes, as it already does. Instead, the OAR with budget authority constitutes an "Institute without walls," allowing AIDS research to be coordinated and made more efficient. Without budget authority, each separate Institute will be its own fiefdom, leading to the kinds of inefficiencies and lost opportunities which occurred during the first decade of AIDS research.

One AIDS treatment organization involved in the issue, Project Inform, has raised other concerns. It sees the issue of OAR budgetary authority as largely symbolic, since either way the NIH director will ultimately make the key decisions, using plans worked out by the OAR and the Institutes. In neither case can the OAR or the Institutes act independently; in both cases, compromise and consensus, not OAR's budget authority, will determine what happens. But Martin Delaney of Project Inform fears that one cost of OAR budget authority is that every year's AIDS research funding will have to be debated with the whole Congress, not just within NIH. Project Inform is not opposing the OAR consolidated budget, but wants more examination of the entire issue -- including the possibility of an AIDS Institute.

Mandatory Testing of Newborns -- Comment

On a separate issue (not decided as part of the omnibus budget negotiations), Congress is likely to require that states with over 10% of the nation's pediatric AIDS cases begin mandatory HIV testing of newborns in two years, unless each state can first meet certain standards through voluntary testing programs. Since the standards proposed appear unrealistic, this legislation will probably require states to begin mandatory testing of newborns -- or sacrifice Ryan White Title II AIDS funding, the penalty for not doing such testing. (Antibody testing of newborns reveals the mother's HIV infection, not the baby's -- and is too late to help prevent transmission of HIV to the baby.)

Language in the legislation requires counseling for pregnant women and voluntary HIV testing, measures long advocated by AIDS and public health groups as the best approach for reducing perinatal infection. But in the same provision, Congress undermines this approach by mandating newborn testing when it is too late to prevent infection.

The most effective way to prevent mother-to-infant transmission would include appropriate prenatal care so that women can use the test results effectively. Most pregnant women with HIV are poor and unlikely to be insured. They may not be able to get the care they need to reduce the chance of transmitting HIV to their children. They may be subject to violence if they test positive and that becomes known. Testing is necessary, but it should be part of a comprehensive program in cooperation with the mother, not imposed on her by Congress regardless of her concerns and her situation.

The real issue is money. It costs money to provide medical care for poor women before, during, and after birth. But it costs nothing for Congress to feel like it is doing something about pediatric AIDS by requiring mandatory testing. This empty gesture will be at the expense of states, which will probably have to cut other AIDS or health programs to comply.


AIDSWatch 1996: National Lobbying Days 
in Washington, May 19-21

A number of organizations are sponsoring this year's AIDSWatch, in which people from across the country travel to Washington D.C. to meet with their Congressional representatives or their staffs. Participants can get help in arranging appointments, and can attend two daily briefings on current AIDS issues and on how to advocate effectively. Last year over 500 people from 40 states participated.

On Sunday, May 19, training, briefing, and registration will be from 2:00 p.m. to 6:00 p.m. at the National Education Association auditorium, 1201 16th St. NW (but check with the organizations involved, in case there are any late changes). After the briefing, the International Candlelight Memorial Washington vigil will be held at Lafayette Park, across the street from the White House, from 6:30 p.m. to approximately 7:00. After the vigil, the official AIDSWatch reception will be at Cafe Sesto, at 15th and K St. NW.

Monday the 20th and Tuesday the 21st are the AIDSWatch Congressional appointment days. Also, there will be briefings at 8:00 a.m. and 4:00 p.m. at the Methodist Building, 110 Maryland Avenue NE, near the Capitol.

For more information, including suggestions on travel and hotel arrangements, contact Lisa Ragain, National Association of People with AIDS, 202/898-0414.


Paris Conference on NAC, 
Similar Therapeutic Approaches, May 21-23

A conference on "Oxidative Stress and Redox Regulation: Cellular Signaling, AIDS, Cancer, and other Diseases" will be held May 21-24, 1996, at Institut Pasteur in Paris. Co-chairs are Luc Montagnier, Catherine Pasquier, and Thomas Tursz; the scientific organizer is Rene Olivier. Speakers include: Lenore A. Herzenberg, "Outcomes of NAC Clinical Trial in HIV-Infected People: Rise in Whole Blood Glutathione and Increased Survival Time"; Leonard A. Herzenberg, "Glutathione and Oxidative Stress: Measures in HIV/AIDS"; and Dr. Wulf Droge, "Role of Cysteine and Glutathione in the Pathogenesis of HIV Infection -- Effects of Treatment with N-Acetyl-Cysteine." There are also several talks on apoptosis (programmed cell death) in lymphocytes in AIDS, and more on other scientific topics; we mentioned the NAC papers because they are more likely to be familiar to our readers. The scientific presentations will be in English.

Detailed information is available on the World Wide Web, http://notes.immunet.org/redox/index.shtml; conference abstracts will later be available on the Web. Registration is through Europa Organization, fax (33) 61 21 28 54 or (33) 61 21 28 57.


Vancouver Conference 
Satellite Meetings, Part II

Our last issue published an overview of the scientific program of the XI International Conference on AIDS (Vancouver, July 7-12, 1996), with notes on travel arrangements, skills building meetings, Community Forum 96, and the satellite meetings scheduled for July 5 and 6, before the official conference begins. We did not have space for the satellite meetings July 7 to July 12, so they are listed here. We do not know of any conference-related meetings scheduled in Vancouver after July 12.

Resistance meeting note: A small invitational workshop on HIV resistance to antivirals occurs every year, often shortly before the international conference (which now takes place only in even- numbered years). This year the Fifth International Workshop on HIV Drug Resistance will meet in Whistler, Canada, July 3-6. A written summary should be available at the Vancouver conference.

Satellite Meetings

July 5 and 6

See AIDS Treatment News #245.

Sunday July 7

  • Asia Pacific Alliance Against AIDS. Private & Public Partnerships for HIV Prevention in Asia Pacific.
  • Indigenous Peoples' Working Group. Indigenous Peoples' Gathering (continues Wednesday July 10).
  • International Women's AIDS Caucus. International Women's AIDS Caucus Meeting.
  • Canadian Foundation For Drug Policy & International Harm Reduction Association. Harm Reduction Around the World.
  • EUROCASO. Networking with Grassroots Organizations through Europe.
  • World Health Organization / UNAIDS. STD/HIV Interactions.
  • European Commission. The Europe Against AIDS Program of the European Commission.
  • Merck Sharp & Dohme. Protease Inhibitors: Treatment Strategies.
  • Hoffmann-La Roche Ltd. Changing Care: Evidence-Based Decisions in HIV and CMV Therapy.
  • Glaxo Wellcome and BioChem Pharma. Turning the Tide Against HIV: Recent Advances in Combination Antiretroviral Therapy.

Monday July 8

  • Gay Men's Health Crisis. Oral Sex Between Men: Research Update and Community Perspective.
  • Vancouver Hospital, Department of Dentistry. Oral Examination Practice Sessions and Identification of Oral Lesions of HIV for Health Care Providers.
  • European AIDS Treatment Group, Berlin, and Positive Women's Network. Women in Treatment Activism 1996.
  • National AETC Program, U.S. Department of Health and Human Services, Health Canada. Trinational Satellite Symposium: Innovative Partnerships in Education and Care between Health Professionals and People Living with HIV (continues July 9.)
  • Sexually Transmitted Diseases Branch, National Institute of Allergy and Infections Diseases, National Institutes of Health. Topical Microbicides.
  • Agouron Pharmaceuticals. Recent Advances in Combination Antiretroviral Therapy.
  • Gilead Sciences. Management of CMV Retinitis: Where Are We Today?
  • Ortho Biotech. HIV Infection and AIDS: New Biology, Therapeutic Advances, Clinical Implications.
  • NeXstar. Update on AIDS Related Liposomal Therapy in the Clinic.
  • Bristol-Myers Squibb Company. Improving Survival in People Living with HIV Infection: Current Therapies, Future Strategies.

Tuesday July 9

  • Hong Kong AIDS Foundation. Global Responses to HIV/AIDS from Chinese Communities.
  • International AIDS Society Lesbian, Gay and Bisexual Caucus. Caucus Meeting: Multiple Risks -- Multiple Threats.
  • International Christian AIDS Network. Celebrating Stories.
  • Panos Institute. On the Margins -- Donor Strategies.
  • Tzu Chi Institute. Complementary Medical Approaches for HIV Infection.
  • Vancouver Hospital, Department of Dentistry. Dental Care of HIV Positive Persons.
  • Living Well Project. AIDS: Combating Misinformation.
  • National Planning Forum for HIV/AIDS Research. Towards an HIV/AIDS Research Strategy for Canada: A Participatory Workshop.
  • Serono Laboratories Inc. State of the Art Approach to AIDS Wasting.
  • Direct Access Diagnostics. HIV and Telemedicine: Increased Access to High Quality Testing and Counseling Services through Technology.
  • Pfizer. The Immunocompromised State and Opportunistic Infections.
  • Boehringer Ingelheim and Roxane Laboratories. Non-Nucleoside Reverse Transcriptase Inhibitors: The New Class of Antiretrovirals.

Wednesday July 10

  • Canadian Hemophilia Society. Hemophilia, Blood Transfusion and HIV/AIDS.
  • Deutsche AIDS Hilfe. Developing New Paradigms for Safer Sex and HIV Prevention.
  • Panos Institute. On the Margins: Community Action.
  • Vancouver Hospital, Department of Dentistry. Clinical Pathologic Conference: Oral Lesions of HIV.
  • International AIDS Society -- USA. Guidelines for Antiretroviral Therapy: Bringing the State of the Art to Clinical Practice.
  • Sexually Transmitted Diseases Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health. Treatment of Sexually Transmitted Diseases to Prevent HIV Infection.
  • Serono Symposia USA Inc. Body Composition for the 3rd Millennium: Advances Since Archimedes.
  • Glaxo Wellcome. Co-Conspirators: Opportunistic Infections in HIV.
  • Abbott Laboratories. Emergence of a New Approach in HIV Disease Management.
  • Bio-Technology General Corp. The Weight Loss Dilemma: The Role of Anabolic Steroids.

Thursday July 11

No satellite meetings are scheduled, as of this time.

Friday July 12

  • AIDS, Medicine and Miracles symposium (for information, call 303/447-8777).
  • National Pediatric & Family HIV Resource Center / Association Francois-Xavier Bagnoud International Pediatric HIV Training Program. Beyond Borders: Caring for the HIV-Infected Child.
  • British Columbia Coalition of People with Disabilities. Strategies in HIV/AIDS Prevention: Education for People with Disabilities.
  • Interagency Coalition on AIDS and Development. Influencing an AIDS-Affected Children and Youth Policy and Program Agenda.
  • International Christian AIDS Network. A Response to Vancouver: Were Faith Based Issues and Responses Acknowledged? Where to Next?
  • International Women's AIDS Caucus. International Women's AIDS Caucus Meeting.
  • St. Paul's Hospital. Ophthalmic Complications of AIDS in Developed and Developing Nations.

Contact Information

Conference Secretariat, XI International Conference on AIDS, 11th floor, 1090 West Pender, Vancouver, British Columbia, Canada V6E 2N7; phone 800/780-AIDS, or 604/668-3225; fax 604/668-3242; email aids96@hivnet.ubc.ca; World Wide Web http://www.interchg.ubc.ca/aids11/AIDS96.html. (Note: the '11' in 'aids11' is the number 11, as this is the 11th International Conference on AIDS; in 'html' the 'l' is the letter 'L'.)




  
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This article was provided by AIDS Treatment News. It is a part of the publication AIDS Treatment News.
 

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