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AIDS Trestment News
June 22, 1998

Contents:


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Agouron and Immune Response to Commercialize Remune™ Immune-Based Treatment

by John S. James


On June 11 Agouron Pharmaceuticals, Inc. and The Immune Response Corporation announced that they have agreed to collaborate on the final development and commercialization of Remune, an immune-based treatment for HIV.

Remune is the HIV treatment vaccine developed by the late Dr. Jonas Salk. It is currently in a phase III trial in which 2500 patients were randomized to receive the treatment or not once every three months -- in addition to standard antiretroviral therapy. The trial finished enrollment in May 1997, and is expected to be completed in April 1999.

Immune-based treatments have been difficult to test, because there is no surrogate marker (like viral load for antiretrovirals) which is well-established for quickly telling if a drug is working, and predicting long-term clinical benefit. Without a surrogate marker, trials must wait for "clinical endpoints" -- persons becoming ill -- to see if those with the new treatment do better than those without it. That is why a Remune trial with 2,500 volunteers is now being conducted.

Agouron decided to get involved after reviewing the data available, including "encouraging preliminary results from a small study of Remune taken in combination with highly active antiretroviral drugs -- results that will be presented at the upcoming 12th World AIDS Conference in Geneva later this month" (Agouron press release, June 11; the reference is to a report to be presented by Fred Valentine, M.D., of New York University).



12th World AIDS Conference, Geneva, June 28-July 3

How to Participate from Home

by John S. James


The World AIDS Conference, the most important single meeting on AIDS, now occurs once every two years; the last one was in Vancouver in July 1996, and the next will be in Durban, South Africa, July 9-14, 2000. This year over 10,000 people will attend the 12th World AIDS Conference in Geneva, Switzerland, starting June 28; a record 7,300 abstracts have been submitted, and about 6,000 of them will be presented or published at the conference. (The theme of this year's conference is "Bridging the Gap" -- in prevention programs and access to treatment between the countries with established market economies, and the resource-poor countries where 90% of people with HIV now live.)

Those not going to Geneva can receive video coverage as well as detailed summaries on the World Wide Web, at any time 24 hours a day, during the conference and for months after. They can also participate in discussions of conference topics through email lists. In some ways it is possible to follow the news better through the Internet than by being in Geneva, since many sessions are simultaneous and it is hard to know in advance what will be important. But teams of experts will attend all the major sessions and write detailed reports of the most important talks; these will be available without charge around the world, often by the next day. And the Internet video will allow users to skip ahead in a lecture, switch to another one at any time, or look back to view a section which only later was recognized as important.

For those without a computer, expert review sessions are available by telephone, or by video in certain cities. And of course AIDS newsletters and other publications will have more extensive and reliable reports than the newspapers. (AIDS Treatment News will report on the Geneva conference mostly in our next two issues, #298 and #299. Issue #298 will be delayed a week and be mailed on July 10, since we will be in Geneva on the regular publication date.)

In addition there will be many local lectures providing expert reviews of the conference; check with AIDS organizations in your area to find out about these. For example, in San Francisco, the University of California AIDS Research Institute and Project Inform will present a Post Geneva Symposium, Monday July 22, 2-5 p.m. on the UCSF campus; for more information, see http://hivinsite.ucsf.edu.

Below are some of the major Web sites for following the results of the conference, official email discussion lists, and some other reviews by telephone or video. All of the information listed in this article is available without charge.

Those following the conference should be aware that it is divided into four major tracks:

  • Track A: Basic Science
  • Track B: Clinical Science and Care
  • Track C: Epidemiology, Prevention, and Public Health
  • Track D: Social and Behavioral Science.

In addition there are officially-recognized "satellite" sessions (in two categories, commercial and non-commercial), and many community and skills-building programs organized or recognized by the conference. There will undoubtedly be public meetings which are not part of the official schedule, but it is hard to learn about these in advance; we only know of a handful, all of them by pharmaceutical companies (which could afford to spread the word independently). We will watch for others through the general literature table at the conference.


Web Sites

  • http://www.aids98.ch, the primary official conference Web site. The conference program, including titles and authors of oral and poster presentations, became available on June 15; you can search the approximately 6,000 titles for any word which appears in the title (choose the Schedule button and follow the instructions provided). The abstracts of these presentations will be placed online later, at about the time the conference begins, and they will be searchable as well. Much more information, including industry and community "satellite" sessions, will also be on this site.

Because Web users around the world could overload a single computer during the conference, the organizers have set up "mirror" sites, other computers with the same material. If you cannot get through at the address above, try one of the following:

  • http://www.unige.ch/imsp/aids98;

  • http://expasy2.hcuge.ch/dmi/aids98;

  • http://www.hon.ch/aids98;

  • http://www.hivnet.ch/mirror/aids98.

  • http://www.webcast.aids98.org, the official conference "webcast" site. Up to 50 lectures each day will be videotaped and placed on the Internet through this site -- allowing people around the world to see the slides presented as well as hear the talks. These lectures should be online about eight hours after they are presented. This site will also have short written summaries of each day of the conference. The lectures will be available 24 hours a day until the end of 1999. Up to 250 selected oral sessions will be posted this way.

    The webcast will be handled through many different computers on all continents, so it can be used by thousands of people at once.

    A technical support desk will be open until one month after the conference, to assist users who may have trouble downloading and installing the free software which their Web browsers need in order to view this video; before calling, check the technical assistance page which will be on the site. If you do need assistance, call the Webcast Help Desk in Atlanta, 404-836-2186; it will be open 24 hours a day during the conference, then from 4:00 a.m. to 5:00 p.m. Eastern time through July 31.

    This program is made possible by a grant from Gilead Sciences, Foster City, California. It is being run by MediTech Media Ltd. (USA), in Atlanta.

  • http://www.healthcg.com/hiv, next-day conference summaries. Each evening a team of over a dozen leading AIDS researchers and technical writers will review that day's presentations, and write extensive summaries which will be available the next day around the world.

    HealthCare Communications Group, which organized this project, has similarly covered several other major AIDS and cancer conferences, producing extensive and in-depth reports of key presentations. Each day's summary can be read in an hour or two, providing a much faster overview than the webcast videos. And these reviews will include poster and other sessions which otherwise may not be widely reported.

    CME (continuing medical education) credits are available. This program is funded by grants from six pharmaceutical companies.

  • http://www.iapac.org, the International Association of Physicians in AIDS Care. IAPAC will publish conference reports on the Web, and will upload a few complete posters (not just the abstracts). Due to the expense, only about 20 selected posters will be available through this program, out of the thousands at the conference.

  • On July 2, two discussions of treatment options by leading HIV experts will be made available through the Web. "New Strategies for Sustained HIV Suppression," a two-hour satellite symposium, and a separate one-hour "Evolving Tactics for Sustained HIV Suppression," will be broadcast by MEDIVISION. These programs are funded by DuPont-Merck Pharmaceutical Company (soon to become DuPont Pharmaceuticals). More information is available at http://www.medivision.com; click the "Big Events" button.


Discussion Forums by E-mail

The 12th World AIDS Conference has set up six email discussion forums, giving those who cannot go to the conference a chance to participate and be heard. More than 500 people have signed up for one or more of these lists so far.

The six topics -- roughly in order of number of subscribers, with the most popular topics first -- are:

  • Community-based research;
  • Access to treatment and care;
  • Human rights;
  • Sex work;
  • Networking among people living with HIV;
  • Immigration.

Also, there is an information list for journalists.

Anybody with email can join these lists to receive the messages, or send messages (including anonymous communications if desired). You can see an archive of the earlier messages on the Web.

More information is available at http://www.hivnet.ch/concerto/aids98, or by email at aids98.community@hivnet.ch.


Telephone and Video Reports

  • Telephone conference call, July 2, San Francisco AIDS Foundation. The San Francisco AIDS Foundation will conduct an interactive telephone call on July 2, while the conference is still in session, discussing what has happened so far. Six research physicians will be on the panel, which will be moderated by Ron Baker, Ph.D., of the AIDS Foundation. This call will begin at noon Pacific time, 3:00 p.m. Eastern time, 9:00 p.m. (21:00) Central Europe time. It is part of the Beta Live series, which is supported by an educational grant from Roche Laboratories, Inc. If you miss the call, you can still hear a recording.

    Advance registration is required. To register to be on the interactive call, phone 800-707-BETA. After the call, if you want to hear a recording by telephone, call 800-550-9235 any time.

  • Video conference in five U.S. cities, July 2, American Foundation for AIDS Research. On July 2, the American Foundation for AIDS Research will present a two-hour live video conference in five U.S. cities: Chicago (Westin Hotel), Los Angeles (Century Plaza Hotel), New York (Essex House Hotel Nikko), San Francisco (Grand Hyatt on Union Square), Washington D.C. (Westin Hotel). A panel of four research physicians and four activists will be moderated by Kevin Robert Frost of AmFAR. RSVP to either 800-572-0661, or khawkins@medisolutions.com, or by fax to 212-696-9295; include your name and phone number, and the city where you will be attending.

  • Post-conference professional and community updates, July 9, video in 15 U.S. cities. On July 9 two panels of experts will review the conference; these sessions will be broadcast by video teleconference to auditoriums in 15 U.S. cities, and available without charge to everyone involved in HIV/AIDS. The first panel (3:30 p.m. - 4:45 p.m. Pacific time, starting at 5:30 p.m. Central time and 6:30 p.m. Eastern time) is for persons with HIV; the second panel, starting half an hour later (5:15 p.m. Pacific time, 7:15 p.m. Central, 8:15 p.m. Eastern) is for all healthcare professionals and HIV counselors. Persons can attend both.

    You can attend this presentation in Atlanta, Baltimore, Boston, Chicago, Dallas, Detroit, Houston, Los Angeles, Miami, New York (live), Newark, Philadelphia, San Francisco, Seattle, and Washington D.C.

    The program is sponsored by the University of Alabama School of Medicine, with funding from Glaxo Wellcome. One hour of CME credit is available for the professional program.

    For registration information, call 877-201-6742 (toll free).

  • A month after the conference, on July 28, a two-hour panel discussion, "The Geneva Report: Treatment Highlights from the 12th World AIDS Conference" will be broadcast by satellite to hundreds of downlink sites in the U.S., and will also be available through the Internet. This program is a joint project of the Johns Hopkins University AIDS Service, the University of California, San Francisco AIDS Program at San Francisco General Hospital, and the U.S. Health Resources and Services Administration. More information will be available on http://hopkins-aids.edu and on http://hivinsite.ucsf.edu.


12th World AIDS Conference Updated CD-ROM

A CD-ROM with searchable abstracts plus slides of the major presentations may be available about 4-8 weeks after the conference. Besides the abstracts, it will have "slides and/or text of plenary talks and track symposia, updated extended summaries and key slides of other oral sessions" -- about 3,000 or more slides. It is expensive, about 150 Swiss franks if ordered before the conference, 250 if ordered later.

For more information, fax Congrex Sweden AB, Attn: AIDS 98, +46 8 661-8155.


Other Geneva Reports

This list is not complete, and many programs are poorly publicized. Watch for announcements of others, especially on Web sites or through local AIDS organizations.



Geneva Arrangements
(If You Are Going)


An 83-page Pocket Programme is now being mailed to those who have registered for the conference. This booklet has travel and conference details, useful telephone numbers and office hours, maps, and other practical information. It also has the conference program (but not the titles and authors of the individual presentations), and lists times and locations of special programs and satellite sessions (which are mostly in the two days before the conference itself).

Starting on June 15, the titles and authors of the abstracts can be read or searched on the official conference Web site, http://www.aids98.ch -- allowing attendees to begin planning their schedules in advance.

We asked the staff for other information which we did not find in the Pocket Programme or on the early Web site:

  • Telephones, laptops. If you want to connect your computer, note that both the power plugs and the telephone jacks are not the same as those of France or Germany. (The electricity is 220 volts, 50 cycles.) While it is best to bring any adapters needed, there will be a place to buy them at the conference. (Be aware that some hotel phones must not be attached to a computer, because they use a digital system with a higher voltage which would damage the modem or the computer; check with the hotel to be sure.)

  • Cell phones. If you want to use a cell phone, one can be rented at the Geneva airport; we do not know how well it will work at the conference center. U.S. cell phones will not work in Geneva.

  • Messages and email. This year the conference message system should be more useful than at previous meetings, since it will be accessible through computers located around the halls (which will also have access to the World Wide Web). In addition, it may be possible to send Internet email from anywhere to someone at the conference through this message system, using their badge number as part of the email address.

    Even if you have no computer equipment or email account, you can set up a free email address through the World Wide Web (using one of the many such services available, such as Hotmail, http://www.hotmail.com, or MailCity, http://www.mailcity.com); then you can send and receive email through that site, either from the computers at the conference, or using other Web access through friends, public libraries, or other organizations. The main disadvantage of free email is that your messages are likely to have advertisements attached.

    If you already have email and want to check your messages from Geneva, ask your service provider how to do so. If you bring a portable computer, there may be a local number to call. If you do not bring a computer, you may be able to check your email at home by using Telnet software; we do not know if this can be done from the public computers at the conference.

  • Press. The computers in the press room have Microsoft Word, and Windows 98 -- which includes Telnet, which some reporters can use to check their email at home. The press room will have a limited number of lockers for storing equipment.



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Metabolic Complications, Growth Hormone Treatment: New Studies Planned


On June 12 the Community Research Initiative on AIDS (CRIA), located in New York City, announced that it will begin two studies of metabolic disorders (fat redistribution, and blood sugar abnormalities) now being recognized more frequently in some persons with AIDS.

  • The first study will follow 30 people for three months when they begin HIV treatment with protease inhibitors. Using a modified oral glucose tolerance test, the study will look for changes in the volunteers' ability to process sugar.
  • A different study will examine the safety and effectiveness of using human growth hormone to treat abnormal fat redistribution -- whether or not the volunteers are also on protease-inhibitor treatment.

These studies are expected to begin in early July; more information will be available after the 12th World AIDS Conference, June 28-July 3 in Geneva. To find out about volunteering, call the Community Research Initiative on AIDS, 212-924-3934.



Ribavirin Approved for Hepatitis C Combination Treatment

by John S. James


On June 3 the FDA approved ribavirin capsules for use in combination therapy "for the treatment of chronic hepatitis C in patients with compensated liver disease who have relapsed following alpha interferon therapy." In the U.S., the drug will be called Rebetol™, and marketed as a combination (called Rebetron™) with interferon alpha-2b, by Schering- Plough Corporation. Schering is selling the ribavirin under license from ICN Pharmaceuticals, Inc. (See AIDS Treatment News issue #295 for two articles about this combination treatment for hepatitis C.)


Comment

Oral ribavirin has long been approved throughout the world as a broad-spectrum antiviral, but has been in limbo in the U.S. for over ten years, due to an old war between the former Commissioner of the U.S. Food and Drug Administration, Frank Young, and the head of ICN Pharmaceuticals, Milan Panic, concerning its use as an HIV treatment. Today, with viral load testing available, ribavirin should be re-evaluated as a possible element in modern antiretroviral combinations. The first step could be a review of the published and otherwise- available data about ribavirin and HIV, to see whether a new trial would be appropriate. An AIDSLINE search finds many recent studies which suggest that this drug might have considerable importance.

Note: also see "Ribavirin and Mortality: New Information," by this writer, published over ten years ago in AIDS Treatment News issue #52, March 11, 1988. (Back issues of AIDS Treatment News are available at the Immunet site on the World Wide Web, http://www.immunet.org/atn.)



Pediatric HIV Treatment: Federal Guidelines Discussed July 22


The U.S. Department of Health and Human Services has organized a two-hour discussion of the Federal Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. This discussion will be transmitted by satellite downlink broadcasts on July 22 from 1:00 p.m. to 3:00 p.m. Eastern time; a videotape may be available later. CME credit is available. As sites register to receive this program, their locations will be posted at www.tech-res-intl.com/hivaids.



Congress: How You Can Help

by John S. James


This summer may be especially important for AIDS research, treatment access, services, prevention, and public policies. No one knows what may come out of Congress; we have talked to both optimists and pessimists.

But everyone agrees that when Congress does move on AIDS funding this year, it will move very rapidly -- because action on the budget has been delayed due to other disputes, and yet politicians will be under pressure to leave early to campaign for the November elections. We can expect a last-minute rush and sloppy legislation, with very little time to address problems that may develop.

We need to prepare now so that people will be ready to call their senators and their representative immediately if necessary, even if there is only a day's notice.

Email is best for receiving action alerts (not for contacting Congress -- usually it's better to call their local office, which takes about one minute as the staff is busy and seldom has time to chat). If you do not have email, there may be a local organization which can send you rapid alerts by fax. Here are a few of the organizations which can send email action alerts on national AIDS issues:

  • AIDS Action Council. Send email to aidsaction@aidsaction.org.

  • AIDS Project Los Angeles. Call them at 213-993-1365 and ask to be placed on their rapid-response email network.

  • National Association of People with AIDS. Call John-Michel Brevelle, 202-898-0414x103; leave your name, street address including ZIP (no P.O. box), telephone, and fax, and email address if any. Or send email to jmbrevelle@napwa.org.

  • Mothers' Voices. You can join their action-alert network through http://www.mvoices.org.

  • Project Inform's TAN (Treatment Action Network). You can join by calling 415-558-8669 ext. 224; or sign up through the Web site, http://www.projinf.org, or by email at tan@projinf.org.

  • San Francisco AIDS Foundation. Call Randy Allgaier at 415-487-3080; you can receive action alerts by either email or fax. You can request national alerts only, or both the U.S. and the California ones.


Comment

Most of these email lists started only recently, so there could be glitches. You may want to sign up for more than one and see how they differ.

The biggest challenge for the organizations is to send alerts that work for people. You should be able to read about the issue in a page or less, then make a couple quick phone calls. And the issue should speak to those receiving the alerts, not only to insiders or professionals.



San Francisco: Six-Week Workshop on Returning to Work


"Going Back to Work If You Have HIV," presented by The Life Program and co-sponsored by Metropolitan Community Church, is a two-hour workshop every Thursday afternoon from July 9 to August 20, at the Metropolitan Community Church, 150 Eureka St., in San Francisco; in addition, in the week after there will be a job faire, probably downtown. There is no fee for this program.

Goals include developing your own plan for: "Maintaining a safety net, just in case; Identifying your job/career interests; Assessing your knowledge and skills; Improving any weaknesses; Finding a job that's right for you; and Your resume and interviews."

For more information, call the Life Employment Program, 415-537-3990.



ISSN # 1052-4207

Copyright 1998 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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