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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.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.
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.
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 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.
