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What's New in Treatment Information, Development, and Policy?
Excerpts From Hotline Memos of December 1999
From the Information Department of Project Inform

January, 2000

Table of Contents:

What's New in Treatment Information?

Structured Treatment Interruption Study

The National Institutes of Health (NIH) is starting a new Structured Treatment Interruption study. Half of the participants will be assigned to continue their existing anti-HIV regimens for 22 months. The other half will be assigned to cycled treatment interruptions. A treatment interruption cycle will include one month off all anti-HIV drugs followed by two months on therapy. These cycles will repeat for 22 months.

To qualify for the study you must:

This study requires that you go to the NIH, located just outside Washington DC in Bethesda, Maryland. You must visit once a month for the first year with fewer visits expected during the second year. However, people assigned to receive the treatment interruption cycles may have to go to the NIH every week during the period when they are off all anti-HIV therapy. The NIH does have a travel budget for people living outside the Washington DC area. However, people have to pay their own way to the NIH for the first visit.

For more information on this study, contact Christian Yoder at the NIH at 1-800-772-5464 ext. 57745 or 301-435-7745.

Mitochondrial Toxicity: The Newest Hot Research in Lipodystrophy

by Tim Horn, reprinted from Community Prescription Service's InfoPack, Vol. 9, No. 3, 1999.

Mitochondria (my-toe-con'-dree-a) are small "organs" in our cells. They are the cell's power plant, using oxygen, fat and sugar to produce adenosine triphosphate (ATP). This process is called "cellular respiration." When the cell needs energy, it breaks down some molecules of ATP to release the stored energy. The more energy the cell needs, the more mitochondria it will contain, anywhere from just a few up to thousands in a single cell. The highest numbers of mitochondria are found in nerve, muscle, and liver cells.

Mitochondria have their own genetic code (DNA). Certain changes (mutations) in this code can cause problems, especially in the brain, muscles, nerves, liver, and kidneys. Some people are born with mutations in their mitochondrial DNA or they can occur naturally. Drugs or chemicals can also cause mutations. Some scientists believe that this is the key to aging. Over our lifetime, the mitochondria accumulate more and more mutations. Eventually these reduce the amount of energy available to the cells. When the energy drops low enough, the cell can experience a "brown-out" and start to malfunction. If the energy drops even further, the cell will have a "blackout" and will stop working.

One of the most common signs of mitochondrial toxicity is muscle weakness (myopathy). If muscle cells can't get enough energy through normal "cell respiration," they have to get their energy without oxygen (anaerobic). This type of energy production gives off lactic acid as a waste product. The soreness that people feel after extreme exercise (like running a marathon) is caused by a buildup of lactic acid. Some people with mitochondrial damage have unusually high levels of lactic acid in their blood.

Mitochondrial toxicity is a "hot" research topic. You'll be reading a lot on this topic in the near future.

What's New in Development?

Academy of Friends Supports Project Inform

Your generosity could put you behind the wheel of a brand new dream car! Don't miss this opportunity! BMW of San Francisco and Academy of Friends present an opportunity to win this special car -- a new 2000 Z3 Roadster Convertible. Courtesy of BMW of San Francisco, this fabulous raffle will benefit Academy of Friends and selected San Francisco Bay Area HIV/AIDS service organizations, including Project Inform.

Ron Wilmot Bike Ride for Project Inform

Saturday, May 13, 2000
Golden Gate Park
Gather/registration at 9:00; ride begins at 10:00

What's New in Policy?

Work Incentives Improvement Act

Disability advocates won a major victory when President Clinton signed the Work Incentives Improvement Act into law on December 17th. His signature was the result of a strong bipartisan effort to craft a bill that would pass the House and Senate, and a major grassroots response by those who would benefit from the bill.

The Work Incentives Improvement Act will provide opportunities for individuals with disabilities, including AIDS, to enter, return to, or stay in the workforce without losing health care benefits. Effective immediately, the bill will extend Medicare Part A premium coverage for 4-1/2 years beyond the current limit for Social Security disability beneficiaries who return to work.

In addition, the legislation gives states the option to allow more working individuals to buy in to the Medicaid program by removing the current income limit of 250 percent of the federal poverty level (about $21,000). This will allow disabled individuals who take jobs at higher wages to maintain their health care coverage. The bill also creates a new state demonstration project that will attempt to provide Medicaid coverage to people whose health does not yet prohibit them from working, but who rely on health care to prevent their condition from worsening. This could help provide Medicaid coverage for working individuals living with HIV, but have not yet progressed to an AIDS diagnosis.

There are other components to this bill, and details are not yet entirely available. There is a fact sheet on this bill on the Social Security Administration's website at In addition, Project Inform will soon provide a more comprehensive analysis of the bill and tips on how to ensure that your state implements the various options available. If you would like a copy of this discussion paper, you can e-mail Ryan Clary at or call (415) 558-8669 x224.

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