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AIDS Treatment News
February 21, 1997

CONTENTS:

Fewer AIDS Deaths and Illnesses: New Information

by John S. James

Two issues ago we reported that AIDS death rates have fallen to about half of what they were previously, in three very different patient populations who have access to modern treatment (see "1997 Outlook," AIDS Treatment News #263, January 17, 1997). The patient groups were people with AIDS in British Columbia (2/3 drop in death rate in two and a half years), inmates at California's medical prison in Vacaville (exact figures not available but probably more than a 50% drop in death rate in one year), and San Francisco residents whose obituaries were published in the BAY AREA REPORTER gay newspaper (at least 50% drop in number of deaths per week, compared to the year before). This article summarizes new information on survival and hospitalization rates presented at the recent Retroviruses conference and elsewhere. All of it shows a large drop in deaths, or in hospitalizations and other evidence of major illnesses, during the last year.

New York City Deaths Decline Almost 50%

Total AIDS deaths in New York City declined from 19.5 per day in January 1996 to 10.1 per day in November 1996, a decline of 48%. Note: Because this decline occurred within 1996, it did not apply to the full calendar year. Therefore, a comparison of total deaths in 1996 vs. 1995 gives a smaller 30% decline when comparing one calendar year with another -- the figure reported in THE NEW YORK TIMES on January 25 ("Deaths from AIDS Decline Sharply in New York City," page 1). The fall in deaths per day (from January to November, the latest month for which figures were available) is more relevant for showing the effect of improvements in medical care which occurred during 1996.

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Exactly what caused the drop in deaths is not clear. The new antiviral combinations with protease inhibitors probably could not by themselves have caused such a large drop, because they were not widely enough available. Other factors widely believed to have contributed have been (1) the campaigns to get people to be tested and get medical care if HIV positive (especially to prevent pneumocystis if their T- helper count is low), and (2) good Federal and state funding for both care and prevention in New York.

Efforts to find the exact causes of this decline (which had never been seen before in the New York statistics and was entirely unexpected) are continuing. Almost certainly there are many improvements -- in HIV treatments, opportunistic infection treatments, prevention of transmission, opportunistic infection prophylaxis, and other advances in medical care and its delivery, which have contributed.

Los Angeles: HIV Specialist Practice Reports Dramatic Reduction in Need for Healthcare Services

A Los Angeles medical center which specializes in infectious diseases and cares for about 480 HIV patients (through contracts with other managed-care organizations) reported a large drop in deaths, opportunistic infections, need for hospitalization, home care, specialist referrals, and other indications of illness, after starting combination therapy including protease inhibitors.(1) The death rate dropped several fold in the last half of 1996 (although this was not emphasized in the presentation) -- and the reduced expenses for medical services more than paid for the cost of the drugs. Peter Ruane, M.D., of Tower I.D. Medical Associates, presented these results on January 23, at the 4th Conference on Retroviruses and Opportunistic Infections in Washington, D.C.

In this fairly advanced patient population (half had a CD4 count lower than 200, and 25% had a CD4 count under 50), only 9% were receiving protease inhibitor treatment in 1995, but about 62% had been prescribed a protease inhibitor by October 1966. In the time between late 1994 and late 1996, the number of hospital days required fell by 57%, and the number of skilled nursing or hospice days fell by 65%.

"These new therapies have completely transformed home care as well," added Dr. Ruane. "In the last six months of 1994 we had 65 people on home care. Now we have five. These drugs clearly reduce the incidence of opportunistic infections. In fact, among compliant patients we have not seen a new case of CMV disease in a year." In two years, home-care use of G-CSF fell 70%, erythropoietin use was down 74%, and CMV treatments fell 90%.

Referrals to specialists also dropped greatly. Radiation treatment was down 80%, total parenteral nutrition (TPN) down 70%, dermatology down 53%, and gastroenterology was down 53%.

Total medication costs increased by 116% in 1996 vs. 1994 (and by 301% for those patients with CD4 counts under 50). But for every $1 increase in medication cost, $2 was saved on other costs (and the savings were higher for patients with CD4 count under 50).

Comment: The Tower I.D. data may be the most complete so far in relating the increased cost of drugs to reduced medical costs elsewhere -- information which is important in advocating for access to care. This is because the total HIV care was delivered under a "capitated" system, meaning that the practice was paid a fixed amount per patient, and provided what care was considered necessary; therefore, all the HIV-related costs were accounted for in the same budget. In many other settings, the drug costs are charged to one institution, but the overall savings to the medical system are scattered among other unrelated institutions, making it difficult or impossible to assemble comprehensive information on the economics of care.

St. Vincents Hospital, New York: Hospitalization Down Despite More Patients Seeking Treatment

Ramon Torres, M.D., reported a major reduction in hospitalization at St. Vincents Hospital in New York -- including a 24% drop in inpatient census from 1995 to 1996, despite an increase in persons seeking HIV care.(2) Cost of antiretrovirals increased 6.7 fold (from $28,471 to $219,446) between 1995 and 1996. (Use of protease inhibitors at the inpatient pharmacy started in 1996, and nucleoside analog use also increased in that year, due to combination treatments.) Dr. Torres noted that it is unclear how the cost of the drugs was offset by reduced hospitalization and other services required.

French Study Finds Triple Combination Therapies Reduce Hospitalization, Save More Than Drug Costs

Changes in antiretroviral use, AIDS-defining events, and hospitalizations were studied at nine medical centers in France, which together care for over 7,000 patients.(3) The three centers which started early in prescribing triple combination therapies with protease inhibitors saved $250,000 (U.S.) per month (by avoided hospitalization costs, minus the cost of the additional drugs). But the three centers which started latest in prescribing the new treatments have not yet reduced hospitalizations enough to pay for the drug costs. (A different breakdown was used in the published abstract.)

AIDS Survival: San Francisco Update

In reporting the decline of deaths in New York, THE NEW YORK TIMES (January 25 article referred to above) quoted an official from the San Francisco Health Department, that deaths reported in San Francisco rose slightly between 1995 and 1996. Since this goes against other findings, we called the Health Department for more information.

The Surveillance office there told us that statistics are kept both as DEATHS REPORTED and DEATHS OCCURRED -- and the latter is more reliable. In March 1996, for example, a periodic reconciliation with the National Death Index was completed, and 300 deaths were added to the 1996 "reported" total -- even though these people actually died in 1993 or 1994. The "deaths occurred" figure shows a steady decrease -- 734 in the first half of 1995, 678 in the second half, and 573 in the first half of 1996. The total for the second half of 1996 has not been released because it is not yet complete. The Health Department noted, however, that "the relative impact that changes in treatment and access to care may have on survival cannot be determined from these data."

Turning to the reduction in the number of obituaries submitted to the gay press in San Francisco -- a less comprehensive but more rapid source of information on changes in the epidemic -- the information we previously reported, that these deaths were running about half or slightly less than half of those last year, currently remains true. The actual improvement is probably better than this, since some of these deaths are not HIV related -- meaning that the HIV deaths would have to decline by more than half to bring the total drop to half.

In San Francisco there is now much interest in returning to work and planning for a future which had not been expected -- dealing with issues such as obtaining medical care when one no longer qualifies for disability. A February 8 forum on "returning to work, protecting benefits, and ideas on how to maximize assets and increase cash flow" had 300 people call to reserve one of the 50 spaces available.

But there are still many deaths -- three per day in San Francisco, and ten in New York City -- from HIV disease. Many of these occur despite the best possible treatment and care. The epidemic is not over.

References

  1. Ruane PJ, Ida J, Zakowski PC, Sokolov RJ, Uman SJ and Daly R. Impact of newer antiretroviral (ARV) therapies on inpatient and outpatient utilization of healthcare resources in patients with HIV. 4th Conference on Retroviruses and Opportunistic Infections, Washington, January 22-26 [abstract #262].
  2. Torres R and Barr M. Impact of potent new antiretroviral therapies on in-patient and out-patient hospital utilization by HIV-infected persons. 4th Conference on Retroviruses and Opportunistic Infections, Washington, January 22-26 [abstract #264].
  3. Mouton Y, Cartier F, Dellamonica P, and others. Dramatic cut in AIDS defining events and hospitalization for patients under protease inhibitors (P.I.) and tritherapies (TTT) in 9 AIDS reference centers (ARC) and 7,391 patients. 4th Conference on Retroviruses and Opportunistic Infections, Washington, January 22-26 [abstract #LB12].


Nelfinavir - Major Trial Results at Retroviruses Conference

Nelfinavir (VIRACEPT(R)) is a protease inhibitor which is expected to be approved soon by the FDA, probably within a few weeks; it is already fairly widely available through expanded-access programs and clinical trials. It appears to have fewer side effects than the protease inhibitors now in use; also it has a somewhat different resistance profile, so that persons whose virus has already become resistant to other protease inhibitors may be able to benefit. Also, it offers new options for combination therapy, both with other protease inhibitors and with other anti-HIV drugs.

At the recent Retroviruses conference in Washington D.C., nelfinavir developer Agouron Pharmaceuticals, Inc. released six-month safety, viral load, and CD4 results from three major clinical trials. All three tested the same two doses of nelfinavir, 500 mg three times a day vs. 750 mg three times a day, in patients with fairly advanced HIV infection (median CD4 counts of approximately 276, 279, and 288, but with relatively high viral loads, averages of approximately 164,000, 142,000, and 151,000 copies, in the three trials respectively). A minimum viral load of 15,000 copies was required to qualify for this trial, so that large decreases in viral load could be seen before reaching the lower cut-off of what the viral load test could measure. [Note: The numbers above, the latest from Agouron on February 19, differ from those in the Retroviruses conference abstract, mainly because average copy numbers are given here, while averages of the logs of the numbers were used in the abstract. Also, some patients are included or excluded differently, based on further analysis of the data in the several months since the abstracts went to press. None of the conclusions have changed.]

  1. The first trial tested nelfinavir alone, with 91 HIV- positive volunteers (both antiretroviral naive and experienced) randomly assigned to one of the two doses. To obtain comparison data with no drug, some of the volunteers were given a placebo for the first four weeks.
  2. Another trial compared d4T alone, vs. d4T in combination with the low dose or the high dose of nelfinavir, in 297 volunteers, most of whom were antiretroviral experienced.
  3. The third trial compared AZT+3TC, vs. the triple combination of AZT+3TC+low dose nelfinavir, vs. AZT+3TC+high dose nelfinavir, in 308 volunteers -- who had little or no prior antiretroviral use (no more than one month of AZT).

All of the trials showed statistically significant improvements in CD4 count and viral load in the volunteers who received nelfinavir, compared to those who did not. The best and most sustained results were with the triple combination -- the one which the company identified as most relevant to prospective clinical use of the drug. After six months, average viral load reductions were 2.3 log (200 fold) and 2.5 log (315 fold) for the triple combination with the low and high doses of nelfinavir, vs. 1.4 log (25 fold) for AZT plus 3TC only. The average CD4 increase was 160 for the nelfinavir-containing arms, vs. 105 for AZT plus 3TC only. Probably most importantly, viral load became undetectable (under 100 copies in the test used) in 65% and 81% of those receiving triple combination with low and high dose nelfinavir, vs. only 18% with AZT plus 3TC only -- despite the fact that all these groups of volunteers had started with a relatively high viral load.

No "clinical endpoint" results are yet available from these trials.

Comment: Dosage Issues

We do not know which dose (500 mg or 750 mg, three times a day) the FDA is likely to approve. At the time of the Retroviruses conference, it was widely feared that the company would seek approval for the lower dose, for most patients at least. A number of doctors who had worked with the drug asked for approval for the higher dose. (And, months earlier, treatment activists had asked that doses higher than 750 mg be investigated.)

The issue seems to be that the trials so far have not shown a statistically significant difference between the doses (except for volunteers with viral load over 100,000 copies, in the triple-combination trial, for whom the 750 mg dose was significantly better than 500 mg). For most patients, the data are equivalent for the two doses -- so far. But only six months of data are now available, and people will of course be using the drug for longer. The fear of many experts is that over time, the virus will escape control of the drug by developing resistance to it -- a process which is facilitated if the dose is too low. This may already be happening at six months in those with the highest viral load, who would be expected to encounter resistance problems first -- as suggested by the statistically significant superiority of the higher dose in the triple combination trial, for those with over 100,000 copies only. It is possible that the reason the doses appeared equivalent for other patients is that at lower starting viral loads, the problem may often take more than six months to develop.

Physicians also want the higher dose approved for reimbursement reasons. If the lower dose becomes official, and then doctors find that they should be prescribing more, there will be serious problems getting payers to reimburse for more drug than the FDA has officially approved. But if the higher dose is approved, doctors will of course have no complaints from payers if they prescribe less.

The company might have the opposite incentive. When a drug is being priced to cover investment, etc., then a lower dose will result in a higher price per gram. Later, moving from the lower dose to a higher dose would mean an automatic revenue increase for the company. Similarly, a move downward from the high dose would result in a revenue decrease outside the company's control.

Of course a lower dose could have the advantage of minimizing side effects -- not all of which are likely to be found in relatively short-term clinical trials. Balancing an additional long-term safety margin against the need for long- term control of the virus will be a difficult, continuing issue. Dosing for all HIV treatments could be improved if tests for blood levels were available to physicians, so that doses could be adjusted for an individual's absorption and metabolism of the drug.

Note: See AIDS Treatment News #263 for information about new nelfinavir expanded-access programs for children and for adults, and about a new clinical trial comparing triple combination with nelfinavir to triple combination with ritonavir.


DANGER: Possibly Fatal Interactions Between Ritonavir and "Ecstasy," Some Other Psychoactive Drugs

by Bruce Mirken

Abbott Laboratories has acknowledged potentially dangerous interactions between its protease inhibitor ritonavir (Norvir(R)) and certain recreational drugs in the aftermath of the death of a British person with AIDS who died after using MDMA, commonly known as "ecstasy," while taking ritonavir.

According to the coroner's report, Phillip Kay's death on October 6, 1996 was caused by an MDMA overdose, with a blood level of 4.56 mg/liter, "nearly ten times that at which we would expect to see serious toxic effects" -- roughly the level that would be expected after taking 22 MDMA tablets. That led his partner, Jim Lumb, certain that Kay would not have taken such an excessive dose, to suspect a drug interaction. He contacted the company requesting data about such interactions, and asked that a warning be issued.

In a letter to Lumb dated Jan. 27, 1997, Dr. P. Kon of Abbott's British division wrote that "Abbott has not conducted, and does not plan on conducting any drug-drug interaction studies between ritonavir and any illegal substances, including ecstasy," but noted that the company's scientists had evaluated the theoretical interaction between the two drugs. Because MDMA's metabolism is mediated by the P450 2D6 isoform, which is partially inhibited by ritonavir, use of the two drugs together could result in"a 2-3 fold increase" in MDMA levels, according to Kon. He added that between 3 and 10 percent of individuals are poor metabolizers of this particular isoform and could see MDMA levels increase "as high as 5-10 fold," though in these individuals such levels could also occur without ritonavir.

Kon declined Lumb's request to issue a warning, writing, "Illegal/recreational drugs are never safe to use, therefore, Abbott will not condone their use under any circumstances."

Lumb provided AIDS Treatment News with a fact sheet which Abbott has made available to British physicians who request it. In addition to MDMA it also lists the following interactions (all are predictions based on known drug metabolism routes and have not been verified by human or animal studies):

  • Heroin: A moderate decrease in heroin concentration (AUC decrease Methadone: A large increase in the concentration of methadone (AUC increase >3-fold) likely. A reduction in dose of >=50% is likely to be necessary. Methadone is metabolized by CYP3A, an isoform known to be potentially inhibited by ritonavir.
  • Cocaine: Interaction unlikely (minimal change in AUC expected) because drug is metabolized by a pathway not known to be affected by ritonavir.
  • Amphetamine: An increase in concentration of 2-3 fold could be expected."

U.S. Abbott spokeswoman Kim Modory said that American doctors can call the company's medical department at 800/633-9110 for information, and reiterated that the company has no plans to issue a general alert: "Abbott is responding to inquiries, but has no plans to issue an alert or recommendations in the U.S. at this time."


Free Viral Load Tests Becoming Available for Uninsured Patients

Two new programs provided by the manufacturers of the viral load tests most used in the U.S. are beginning to make free tests available to those with no way to pay for them. Usually you need to be HIV-positive, have a doctor who has ordered the test, and not be able to cover the cost through private or public insurance.

[Note: These programs exist because AIDS treatment activists from many organizations have pressured and negotiated for them. They are like the "patient assistance programs" under which many pharmaceutical companies give free drugs to persons who otherwise could not get them. But the testing programs are more difficult than the drug programs, because much of the expense of testing is for laboratory work, which is usually not done by the test manufacturer but by third parties; therefore it may not be enough for the companies to donate their own product. These new programs still have some problems, and activists are working to get them resolved.]

The two kinds of viral load tests which are most readily available -- PCR (polymerase chain reaction, by Hoffmann-La Roche) and branched DNA (by Chiron Corporation) -- are largely equivalent. But it is advisable to get the same kind each time, since there can be differences in how the tests measure a particular virus. In practice, the choice is likely to depend on which test one can obtain through the programs -- or which test one's physician is most familiar with.

One phone number to start with is 1-888-HIV-LOAD (9 a.m. to 9 p.m. Pacific time, Monday through Friday -- 11 a.m. to 5 p.m. Saturday and Sunday). This trilingual hotline (English/Spanish/Filipino) is run by the San Francisco AIDS Foundation, with assistance from Chiron Corporation and the San Francisco Department of Public Health. The Chiron program is now officially available in San Francisco, Boston, and Chicago -- and pending startup in Los Angeles, Houston, Miami, Philadelphia, and New York. In cities where the Chiron program is not available, this hotline will refer people to the Hoffmann-La Roche program (see below).

Another phone number to start with is 1-888-TESTPCR (9 a.m. to 5 p.m. Eastern time, Monday through Friday). This hotline, run by Roche Diagnostic Systems, primarily helps people find out what reimbursement systems they may qualify for to pay for the test. But if reimbursement turns out to be impossible, this office can also arrange for access to free testing, although so far the new program has served a small number of people. (An earlier Roche program offered two free baseline viral load tests -- see AIDS Treatment News #248 -- but problems developed because it was impossible to keep up with the demand.)

We will publish more information as experience develops on how well these new programs are working in practice.


ABT-378: Abbott & "Second Generation" Protease Inhibitor

by John S. James

The first public data on ABT-378, a new protease inhibitor designed to be effective even against HIV which had become resistant to the approved protease inhibitors, was presented in several talks and posters at the 4th Conference on Retroviruses and Opportunistic Infections. These results were based on tests in the laboratory and in several animal species; ABT-378 has not yet been tested in humans.

ABT-378 was designed to take advantage of the fact that HIV resistance to ritonavir (Norvir(R), Abbott's approved protease inhibitor) and to indinavir (Crixivan(R), from Merck) usually starts with a mutation at position 82 in the HIV gene which encodes for the protease enzyme (the target of protease inhibitor drugs). ABT-378 does not use this position when it binds to its target on the protease enzyme. As a result, ABT-378 is active against viruses which have become resistant to ritonavir or indinavir.

It is possible to create HIV which is partly resistant to ABT-378, by exposing the virus to low concentrations of the drug. But so far, the resistant virus created in this way has remained fully sensitive to saquinavir (Invirase(TM)). And in animal tests, even the trough level of ABT-378 (the lowest level in the blood between doses) is more than enough to be effective against this partly resistant virus -- meaning that the drug may be able to suppress even this resistant HIV.

ABT-378 by itself is eliminated from the bloodstream fairly rapidly, so if the drug were used alone it would have to be taken often during the day. But a small amount of ritonavir (probably a fraction of the usual dose) delays the body's destruction of ABT-378 enough that the drugs are expected to be dosed only twice a day, or even only once a day.

ABT-378 is about ten times as active as ritonavir against "wild type" HIV (viruses from patients who have not developed drug resistance), and about as active against ritonavir- resistant viruses as ritonavir is against non-resistant ones.

Abbott plans to begin human trials later this year.

Comment

No one knows if a drug will work until human testing has been done. But whatever the fate of ABT-378, the message from its development is that drug resistance is not something beyond human control, but can be minimized by careful design of a new drug's chemical structure -- and by maintaining high concentrations of the drug in the blood at all times.


Drug-Related Neuropathy: Low Acetylcarnitine Levels Found

by John S. James

Persons who had peripheral neuropathy which appeared to have been caused by ddI, ddC, or d4T were found to have a notably low level of acetylcarnitine in their blood1; however, their blood level of L-carnitine was normal. As a control, patients who were taking ddI but did not develop neuropathy were also tested -- and they were found to have acetylcarnitine levels which were only slightly reduced. This study did not give acetylcarnitine to any patients, but suggested trying that experiment to see if the drug could help prevent or treat this kind of neuropathy.

Acetylcarnitine (also spelled acetyl-carnitine) is not the same as L-carnitine (a readily available nutrient), but they are chemically related. The body can convert L-carnitine into acetylcarnitine -- but in this case, since the patients' L- carnitine levels were normal, the researchers suggested that this conversion may have been impaired. Acetylcarnitine is known to be important in nerve functioning and in protecting nerves from injury, in part by enhancing the activity of nerve growth factor.1

"Since acetylcarnitine is currently available for the treatment of neuropathies and has no toxic effects, the exogenous supplementation of acetylcarnitine in order to prevent or treat the neurotoxicity of nucleoside analogs appears a reasonable hypothesis."1

Comment

Acetylcarnitine is being tested in people for treating a number of conditions, but we do not know of its use in HIV. It can be given orally, but may need to be taken several times a day (until a time-release formulation is made) because it has a short half-life in the body. We do not know if acetylcarnitine is readily available in the U.S. or elsewhere.

This possible treatment needs more research. If you have any information about use of acetylcarnitine with HIV-related conditions, please contact AIDS Treatment News, 415/255-0588, or aidsnews@aidsnews.org

References

1. Famularo G, Moretti S, Marcellini S. and others. Acetyl- carnitine deficiency in AIDS patients with neurotoxicity on treatment with antiretroviral nucleoside analogues. AIDS. February 1997; volume 11, number 2, pages 185-190.


San Francisco: 9th National AIDS Update Conference,  March 18-22

The annual National AIDS Update Conference in San Francisco is primarily intended for "physicians, nurses, dentists, hospital and public health administrators, social workers, and mental health practitioners, ... policy makers involved in community-based organizations and other allied practitioners concerned with the prevention and management of HIV/AIDS infection." It is sponsored by at least 35 organizations, including the American Foundation for AIDS Research, the American Medical Association, the U.S. Centers for Disease Control and Prevention, the San Francisco Department of Public Health, and several programs of the University of California. This is a professional education conference, but not a forum for release of new research information.

Continuing education credit is available for physicians, nurses, and health educators, and for social workers for some purposes.

The conference will take place March 18-22 at the Civic Auditorium in San Francisco. For more information, call Krebs Convention Management Services, 415/255-1297.


New York: "Management of  the HIV-Infected  Patient"
March 7-9

A continuing medical education course for primary care physicians, co-sponsored by the American Foundation for AIDS Research, will be held at the Crown Plaza Manhattan, March 7- 9. The program directors are Ellen C. Cooper, M.D. M.P.H., H. Clifford Lane, M.D., and Henry Masur, M.D.

This meeting focuses on practical clinical issues, with sessions on the major opportunistic diseases, plus topics like "Initial Assessment and Follow-Up Strategies by the Primary Care Physician," "Viral Load Monitoring: Role in Clinical Practice," "Antiretroviral Therapy: Initial Selection and Long-Term Management: Current and Future Options," "How to Work Up Common Clinical Problems," and "Immunomodulators in Clinical Practice, and Current Status of Vaccines."Continuing education credits are available for physicians, physicians in training, and allied health professionals. It is possible to register for a single day without paying for the entire 3-day conference.

For more information, call the Center for Bio-Medical Communications, Inc., 201/385-8080, email cbcbiomed@aol.com.


New York: ACT UP 10-Year Anniversary Activist  Conference Mar. 22-23,
Wall Street Demo March 24

ACT UP/New York is hosting an ACT UP 10-year anniversary celebration, March 22-24. The main events will be a national activist conference Friday evening March 21 through Sunday March 23, followed by a Wall Street demonstration supporting access to treatment in the U.S. and around the world, and protesting pharmaceutical prices, on Monday morning, March 24, beginning at 7:30 a.m. at the fountain in City Hall Park. Social events are planned for Friday and Saturday nights.

For more information, call the new ACT UP/New York voicemail number, 212/966-4873 (press 4). You can also call that number from a fax machine to request information by fax.

San Francisco note: A spaghetti dinner benefit to raise funds for travel to the New York events will be held Monday, March 10, in San Francisco. Tickets are $10. For more information call ACT UP/Golden Gate, 415/252-9266 or 415/252-9200.


Retroviruses Conference Information: Tape Sales; Email Access

In our last issue we listed some of the major Web sites with reports or other information from the 4th Conference on Retroviruses and Opportunistic Infections, Washington, January 22-26 (see "Retroviruses Conference: Where to Get Information," AIDS Treatment News #264). Here are two other information sources which we have not listed previously.

Audio Tapes Available

Audio tapes are available from 17 of the 39 oral sessions, at $11 per one-hour tape (most of these sessions are two tapes). For an order form (for tapes from the 4th Conference on Retroviruses and Opportunistic Infections) contact Sound Images, Inc., 7388 South Revere Parkway #806, Englewood, Colorado 80112, phone 303/649-1811, fax 303/790-4230, email 103107.1750@compuserve.com.

Note: Usually the same sessions available on tape are also available through the official Retroviruses conference Web site, www.retroconference.org -- which has the advantage of including some of the slides. When we last checked, a few sessions were available only by tape, and a few others only through the Web. The sessions which are available tend to be the overview or educational ones (but at an advanced level, for scientists or physicians). None of 15 "slide presentations," where many of the new findings were released, are available in any form; since these were presented in five simultaneous tracks, even those who attended the meeting could not get to most of them. Fortunately you can obtain some of the information presented through independent reports available without charge through the Internet (see "Retroviruses Conference: Where to Get Information," ).

Email Access to Some Reports from the Conference

Persons or organizations who only have email, but not access to the World Wide Web, can get the "AIDScan" summaries of the Retroviruses conference (provided without charge by the Journal of the International Association of Physicians in AIDS Care) from the AEGIS computer (AIDS Education Global Information System, run by Sister Mary Elizabeth). A very large collection of other AIDS information is also available in the same way. You send email with the name of the file you want to the AEGIS computer, and it responds automatically by sending the requested file back to you by email. This system is not as convenient as using the World Wide Web, however (or using Telnet to aegis.com, if you can connect to the Internet but do not the hardware or software needed for the World Wide Web).

For email access, send your requests to:

ftpmail@aegis.com

The subject line should be left blank. The first line of the message must be:

get

where is the name of the file you want. Only one file can be requested per message. The "AIDScan" reports are available in 20 files, with the following files names: as970101.txt, as970102.txt, as970103.txt, etc. through as970120.txt.

To see what other AIDS information is available through this system, you can request a file list, which has the name of each file and a one-line description of its contents. This list is fairly large, however, about 250K. To request the list, send email to the same address, but on the first line of your message, say:

get filelist.txt

or for a compressed copy, which you must uncompress after receiving, say

get filelist.zip

Note: If you can use the World Wide Web, the AEGIS information is available at http://www.aegis.com . Or if you do not have Internet access, you can dial directly to the AEGIS bulletin board at 714/248-2836 -- which usually requires a toll call, of course.

The information from the International Association of Physicians in AIDS Care is also available through their site, http://www.iapac.org/conferences/aidscan3/preliminary.html.


Medical Marijuana: Nationwide Poll Shows 2-1 Support

A professionally conducted poll of 1,002 Americans between February 5 and 9 found two-to-one or greater support for allowing doctors to prescribe marijuana for seriously or terminally ill patients. This poll was conducted by Lake Research, and International Communications Research, for the Lindesmith Center, a drug-policy organization.

Two questions were asked:

(1) "Should doctors be able to prescribe marijuana for medical purposes to seriously or terminally ill patients?"

The response was 60% in favor, 30% opposed, nine percent don't know, one percent refused to answer.

(2) "As you may know, voters in two states recently passed laws allowing doctors to prescribe marijuana to seriously ill patients for medical purposes. The federal government says that doctors who prescribe are violating federal law, and has threatened to prosecute them or suspend their license. Which comes closer to your views: doctors should be able to prescribe marijuana for medical use in states where it is allowed by law, or the federal government should penalize doctors who prescribe marijuana, regardless of whether state law allows them to?"

The response was 68% allow doctors to prescribe, 24% penalize those doctors, two percent do not agree with either, four percent are unsure, and one percent refused to answer. (The order of the two responses was changed when the question was asked, to avoid biasing the results by having one choice consistently offered first.)


Medical Marijuana: Followup on THC Toxicology Report

Our last article on medical marijuana reviewed a major government toxicology study of THC, the main active ingredient in marijuana (see "Medical Marijuana: Unpublished Federal Study Found THC-Treated Rats Lived Longer, Had Less Cancer," AIDS Treatment News #263). Although the results of this study unanimously passed peer review in June 1994, the findings were not released for two and a half years. Our article, which was the first public mention of the study, was picked up by the BOSTON GLOBE and then by the Associated Press (with credit to AIDS Treatment News both times). The Associated Press noted that the office of "drug czar" Barry R. McCaffrey was not aware of the $2 million study.


Copyright 1997 by John S. James. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used.




  
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