Contents:

1. Viral Load Seminars in January and February, Eight U.S. Cities
2. d4T+AZT -- Unexpected CD4 Drop Seen in Study
3. 1592: Consensus Letter on Access to New Glaxo Drug
4. Call for Research on Better Use of Existing Drugs in Advanced Disease
5. National Conference on Women and HIV -- Late Breaker Deadline March 21
6. Geneva AIDS Conference Seeks Community Planning Coordinator
7. Vaccine Report Available
8. Reminder: AIDS Treatment News Reader Survey
9. Medical Marijuana: Legal Issues for Physicians and Others
10. Marijuana and Research
11. AIDS Treatment News 28-Page Index
12. AIDS Treatment News Index for 1996

Viral Load Seminars  in January and February,  Eight U.S. Cities

Roche Diagnostics will present a free half-day seminar on viral load in eight U.S. cities in January and early February. The seminars will be in the morning, except the one in Washington D.C., which is scheduled for the afternoon. The cities and dates are: New York, January 6; Boston, January 8; Chicago, January 9; Coral Gables, January 10; San Francisco, January 13; Beverly Hills, January 16, Washington D.C., January 21; and Atlanta, February 5. For more information, contact The Organizing Secretariat, 3112 East Shadowlawn Avenue, Atlanta, GA 30305, 404/233-6446, fax 404/233-2827, email kristina@meditech-media.com.

d4T+AZT  - Unexpected CD4 Drop  Seen in Study

On November 22 the National Institutes of Health issued a Note to Physicians recommending that physicians closely monitor the CD4 counts of patients taking a combination of d4T plus AZT. The reason was that an ongoing study (ACTG 290) found an unexpected decline in CD4 count of volunteers assigned to that combination, who also had much prior experience with AZT. In ACTG 290, volunteers had CD4 counts at study entry between 300 and 600, and had a median of 34 months' use of AZT. Those assigned to the d4T plus AZT combination arm had an unexpected CD4 drop -- 20 cells at week 4, to 82 cells at week 36. There were no unexpected CD4 declines in other arms of the study (d4T alone, ddI alone, and ddI plus AZT). "No significant differences in adverse events, serious laboratory toxicities, or HIV-related clinical events" were found in any of the groups. The ACTG has discontinued the d4T plus AZT combination arm, and offered volunteers a new study arm with d4T alone for eight weeks, with very close monitoring. Another study (ACTG 298) also had a d4T plus AZT arm, but had no unexpected decline. The only apparent difference is that in this study, the volunteers had less than 7 days of prior AZT experience. No one knows why the CD4 decline occurred, and additional research is being done to try to find out. Meanwhile, the research is being done to try to find out. Meanwhile, the Note to Physicians does not make any recommendation on whether or not to discontinue this combination, but advises physicians to closely monitor CD4 counts of patients taking it.

1592: Consensus Letter on  Access to New Glaxo Drug

A consensus letter signed by dozens of AIDS organizations and individuals calls on Glaxo Wellcome to establish an expanded- access program for 1592, a promising HIV treatment now in human trials. The letter calls for three stages of access: (1) A compassionate use/salvage therapy program "without delay" for those in most urgent need; (2) A larger expanded access program, designed to avoid possible interference with recruiting for large-scale clinical trials; and (3) Accelerated approval (marketing approval based on viral load and other measurements of the drug's activity, without waiting for completion of long-term "clinical endpoint" trials). This letter has already been signed by 46 organizations, including AIDS Healthcare Foundation, AIDS Project Los Angeles, Gay Men's Health Crisis, National Association of People with AIDS, San Francisco AIDS Foundation/BETA, ACT UP/Boston, ACT UP/Golden Gate, ACT UP/Los Angeles, ACT UP/New York, ACT UP/Philadelphia, AIDS Treatment News, Log Cabin Republicans, Mothers' Voices, POZ Magazine, Project Inform, PWA Health Group, and Treatment Action Group -- and over 100 individuals. More organizations and individuals are needed. You can obtain a copy of the letter from the Linda Grinberg Foundation, fax 310/471-4565 or phone 310/471-4108; leave your fax number or mailing address.

Call for Research on  Better Use of Existing Drugs  in Advanced Disease

In its current newsletter, Project Inform is calling on the AIDS community to advance two lines of research which are especially important to persons with advanced disease: resistance testing to tell which antiretrovirals are no longer working for a patient, and alternative drug delivery systems for those who cannot effectively take the drugs orally. Today, when a combination treatment starts failing, doctors usually do not know which of the drugs may still be working. And many patients do not have enough options left to start three or more different drugs which they have never used before. What is needed is more widespread access to viral tests to rule out those drugs which will not work because the virus has already become resistant to them. Such testing already exists, but it is experimental and expensive. There must be more research, wider access, and eventually official approval. On the drug formulation issue, there is much effort today to teach patients the importance of using their treatments (especially protease inhibitors) as directed, to avoid blood levels which are too low and can lead to rapid development of resistant virus. But much less attention has been paid to the problem that some patients cannot absorb the drugs properly, especially those with advanced HIV disease and gastrointestinal problems. Much more effort is needed on developing intravenous formulations or other alternatives to oral delivery. These two areas will be important in AIDS activism in 1997 and beyond. For more information, see "Closing the Gap: Next Steps in Optimizing Therapy," in PI PERSPECTIVE #20, November 1996. It is available from Project Inform, 800/822-7422 or 415/558- 9051, 10 a.m. - 4 p.m. Pacific time, or by fax 415/558-0684, email pinform@hooked.net, or World Wide Web http://www.projinf.org.

National Conference on  Women and HIV  -- Late Breaker  Deadline March 21

The National Conference on Women and HIV will be held near Los Angeles in May 1997. Although the regular deadline for abstracts from persons who want to present at this meeting has passed, late-breaker session abstracts will be accepted until March 21. Grassroots and community-based people are encouraged to make a presentation, which can be an oral talk, slide presentation, or poster. To reach the conference organizers, contact Alexandra Minnis, 800/845-2115 or 213/351-8196, or send email to womenconf@aol.com, or check the Web site http://www.womenhivconf.org.

Geneva  AIDS Conference Seeks  Community Planning Coordinator

The 1998 International Conference on AIDS seeks a full-time planning coordinator, who will be based in Geneva from early 1997 through August 1998. This person must be fluent in both French and English, and able to work in a team and under tight deadline pressures. If you are interested, send a CV/resume and cover letter to the Conference, fax 41-22-372-98-20, email florian@hivnet.ch.

Vaccine Report Available

It is widely agreed that only a vaccine will be able to stop the worldwide AIDS epidemic, and that an effective vaccine could save tens of millions of lives. But little is happening in vaccine development, with only a handful of companies having comprehensive HIV vaccine programs, and government not having provided the leadership which industry needs. The AIDS Vaccine Advocacy Coalition, an activist group with funding from the American Foundation for AIDS Research, Broadway Cares, and Until There's a Cure Foundation, interviewed scientists and officials confidentially at 23 companies with active or former HIV vaccine programs to find out what is needed. They found little if any doubt that an HIV vaccine will be possible, but much scientific uncertainty about which approaches might work. This scientific unknown emerged as the single greatest obstacle to an effective HIV vaccine effort. It is widely agreed that government must fund the basic research effort to answer key questions, such as identifying what immune responses are important against HIV. Then private investors will have paths to follow toward product development. The AVAC report, INDUSTRY INVESTMENT IN HIV VACCINE RESEARCH, is available for $9.95 from the AIDS Vaccine Advocacy Coalition, 2215 Market Street, #501, San Francisco, CA 94114. Comment Fortunately one major obstacle -- lack of any one person in government responsible for the vaccine effort -- has been addressed since the report was written. On December 12 the Office of AIDS Research announced that Nobel Prize-winning virologist Dr. David Baltimore would be in charge of HIV vaccine research at the U.S. National Institutes of Health. Dr. Baltimore's appointment has been well received by the AIDS community. Individuals can help, by getting AIDS organizations involved. So far few have even put vaccine development on their lobbying agenda. "The important thing is, are everyday people talking about it?" said one communications expert recently, addressing a different issue. Vaccine organizations building grassroots support should ask what is required to move the issue toward "the center of interpersonal discourse."

Reminder: AIDS Treatment News  Reader Survey

Readers are reminded to return the one-page survey which appeared in the last issue, #260. We are already using this survey to help decide what to publish in this newsletter. Let us hear from you about what you do or do not want us to cover.

Medical Marijuana:  Legal Issues for Physicians, Others by Bruce Mirken

On November 6 voters in California and Arizona passed ballot initiatives intended to allow medical use of marijuana by those suffering from illnesses for which the herb may provide relief. Unfortunately, considerable doubt remains about the practical effect of the measures, particularly regarding possible dangers to physicians who recommend use of cannabis -- an important issue, since such doctor recommendations are required in order for patients to invoke the new laws. In Arizona, organizers of the campaign for Proposition 200 (a far-reaching measure which also commits the state to placing nonviolent drug offenders in treatment programs instead of prison) do not expect the law's medical marijuana provision to get much immediate use. Campaign coordinator Sam Vagenas said that he expects the combination of prosecutors' hostility toward the new law and the state's harsh drug laws, which make marijuana possession a felony in most cases, to stifle use of Prop. 200 until a test case is decided by the courts. "We expect this to be litigated," Vagenas noted, "and we do not expect a lot of usage until that litigation occurs." In California the situation is quite different. Even before the passage of Prop. 215, the state's relatively mild marijuana possession laws and the at least tacit cooperation of some local authorities allowed a number of medical marijuana buyers' clubs to exist. Despite state Attorney General Dan Lungren's much-publicized raid on one such operation in San Francisco, a number of clubs continue to operate. This does not mean, however, that patients, doctors or distributors of medical cannabis face a clear path. A major unresolved question is whether doctors will face reprisals for recommending marijuana, a Schedule I drug which they are not legally allowed to prescribe. Prop. 215 was written to protect doctors, both by requiring only a "recommendation" of marijuana rather than a formal prescription and by barring the state from taking action against doctors for making such recommendations. These provisions, however, do not give physicians complete protection. The California Medical Association, which opposed Prop. 215 on the grounds that there is insufficient study data supporting therapeutic use of marijuana, has issued an information sheet for doctors that urges caution and cites possible dangers. The CMA warns that physicians acting under 215's provisions "may be subject to serious liability" under federal drug laws which are not affected by the measure. "Federal law," the CMA notes, "establishes a clear prohibition against knowingly or intentionally distributing, dispensing or possessing marijuana" and "gives an extremely broad scope to the terms 'distribute' and 'dispense.'" The CMA cites one particular federal court decision, the 1977 case of United States vs. Davis, which seems to allow federal prosecution of doctors for "creating the means" for individuals to obtain illegal drugs. This and other cases, the CMA argues, suggest possible criminal liability even for "physicians who, in good faith, are trying to protect their patients' health." And even if doctors are not prosecuted they might face other federal sanctions, such as action to revoke the physician's Drug Enforcement Agency registration, making it impossible for him or her to prescribe legal controlled substances ranging from morphine to anabolic steroids. Although the CMA believes the safest course for doctors is not to recommend marijuana at all, the organization suggests that those who choose to make such recommendations use statements such as these: 1) That the patient has [a specific medical condition] for which there is evidence that the use of marijuana is sometimes medically warranted. 2) That in the physician's medical judgment, the patient would benefit from the medical use of marijuana. 3) That, because federal law prohibits dispensing, distributing, possessing and cultivating marijuana, the physician cannot legally prescribe marijuana for the patient." The CMA document notes that use of such statements does not guarantee that doctors will be safe from federal sanctions, but "may reduce the likelihood of such liability." Many doctors are giving recommendations to their patients, and on Dec.4 a doctor's testimony produced the first known Prop. 215-related dismissal of marijuana possession charges in a case in Amador County. But many health care providers are approaching the new law cautiously. Michael Weinstein, president of the AIDS Healthcare Foundation, a major nonprofit provider of HIV/AIDS medical services in Los Angeles County, said that AHF is allowing its doctors to make their own decisions regarding recommending marijuana, but has asked them not to put such letters on AHF letterhead. Weinstein reaffirmed AHF's support of 215 but said the foundation did not want to "be first in line" to be a test case. What no one knows at this point is whether federal authorities will aggressively enforce marijuana laws against doctors or others. Officially the Justice Department is saying very little so far. According to spokesman Gregory King, "The Attorney General has stated on several occasions that federal law still applies and that prosecutorial judgments will be made on a case-by-case basis. The Department of Justice is currently reviewing other alternatives that might be appropriate responses." King flatly declined to specify those "other alternatives." There are some indications that government's approach may be overtly hostile. Federal "drug czar" Gen. Barry McCaffrey insisted at a Dec. 2 Senate hearing that Prop. 215 had nothing to do with the medical needs of sick people and was part of a dangerous "national strategy to legalize drugs." Bizarre as McCaffrey's statements may seem to Californians who support the measure, a Washington, D.C source familiar with Clinton Administration thinking on the matter (who spoke to AIDS Treatment News on condition of anonymity) said that such ideas are in fact driving the government's decisions about how to react to the California and Arizona laws. Although a few states, including Connecticut, have long had statutes providing for medical use of marijuana without arousing the federal government, the source said that federal drug enforcers are genuinely alarmed by the recent initiatives. Policy makers "think George Soros (a New Yorker who contributed heavily to the Arizona and California campaigns) just sent a bunch of money to help out drug dealers," the source said. As for the idea that marijuana may have legitimate benefits for people fighting terrible illnesses, "They don't get it. They don't get it at all." The source added that the federal government is unlikely to prosecute patients using marijuana for fear of a public relations backlash, and for that reason the government almost certainly will not attempt to challenge the laws in court, since such a case would have to be built around the arrest of a medical marijuana user. But prosecution of distributors, which might include the buyers' clubs, remains a possibility. A number of other possible actions are under active consideration, including an effort to draft a Federal bill aimed at effectively nullifying the two initiatives. Such legislation, the source predicted, "would just zoom through this Congress." Californians for Medical Rights, the organization that sponsored Prop. 215, is working on strategies to protect doctors, according to campaign manager Bill Zimmerman. The group has begun discussions with both the CMA and state legislators aimed at drafting legislation to bolster the new law and produce "some clarification from the federal government as to what they will and won't do," Zimmerman said. And if the government tries to punish physicians by revoking their DEA registrations, Zimmerman said, "They might be subject to a lawsuit by the doctor for depriving them of the right to make a living. Since all that the initiative requires is a recommendation, there could be a First Amendment free speech issue as well. We're going to have a first-rate team of lawyers in place to make the arguments and file the lawsuits if necessary."

Marijuana and Research by John S. James

The Current issue of SYNAPSE, a newspaper published by medical students at the University of California San Francisco, reports a case which may be an early test of California's Proposition 215. Alan Martinez, a 40 year old nurse's aide from Santa Rosa who uses marijuana for epilepsy which he has had since age 19, was arrested in August for growing plants in a windowsill box; his lawyer had the case postponed until after the November election, when California voters made clear that they do not want medical marijuana treated as a crime. Martinez, who says he was largely disabled while using conventional epilepsy drugs alone, spoke publicly for the proposition during the campaign. ("Man with Epilepsy Cites 'Medical Use' in Marijuana Case," SYNAPSE, December 5, 1996.) Martinez called for research on medicinal uses of marijuana. A medical expert interviewed for the SYNAPSE article said it was plausible that marijuana could affect the threshold for seizures, although the question was unanswered because no large studies had been done in people. Ironically, one of the most extreme opponents of the medical marijuana initiative -- California Attorney General Dan Lungren -- is also calling for research. Lungren wants the U.S. FDA to determine what if any medical uses of marijuana are legitimate -- presumably hoping for a short list giving him authority to keep prosecuting anyone who uses marijuana for any other diagnosis. In the past, opponents of medical marijuana have often used the lack of research to justify their opposition -- while any research which could possibly establish an accepted use was blocked by Federal authorities. One of the arguments against Proposition 215 during the campaign was that before marijuana could be accepted as a medicine, it would have to be proved safe and effective, like other drugs. But FDA approval of the efficacy of an herb would be very unusual; the FDA usually approves chemicals which can be uniformly manufactured. Other herbs are used in medicine without FDA approval. What Marijuana Research Is Needed? Today, with rapidly growing support for medical marijuana research, we need to think carefully about what research is needed. Some of the claimed benefits of marijuana can be physically measured -- intraocular pressure in glaucoma, weight gain in wasting, or amount of vomiting in chemotherapy or with other severe digestive conditions. Because some of these benefits are short-term, they could be tested quickly and at little cost. But medical marijuana is usually used for RELIEF -- which is often inherently subjective and very difficult to measure scientifically. And ultimately, does it really make sense to try to quantify short-term subjective relief -- as opposed to trusting persons who are seriously ill to try different possible treatments and select what works for them? Do we have to try to measure relief anyway, even if it does not make medical or scientific sense to do so, because of political demand? Another question in marijuana research is what do we want to compare. One possibility would be smoked marijuana vs. dronabinol (Marinol(R)), a legal prescription drug which contains THC (tetrahydrocannabinol), the main active ingredient of marijuana. And yet, what would be the value of knowing that, on the average, marijuana worked a little better, or dronabinol worked a little better, or (more likely) that the trial was not big enough to tell definitively? Anyone who knows patients knows that dronabinol works much better for some, and marijuana for others; how useful are gross averages, when the drugs are working for different people? (A better trial design might compare three arms: marijuana vs. dronabinol vs. CHOICE by the patient and doctor of whichever of the two worked best for that person. But -- except as a pilot study to work out the practical problems in researching marijuana -- is there really a medical reason for such a trial?) The marijuana research we most recommend would be development of pharmaceutical THC in an inhalable form. Almost all descriptions of why marijuana worked for someone when dronabinol does not, cite either: (1)the ability to control the dose through smoking, or (2) difficulty using the (oral) Marinol due to gastrointestinal problems (or (3) the exorbitant price of Marinol, if insurance will not pay, but that is another issue). An appropriate form of THC supplied with a device to heat it (not burn it) would provide both of the medical advantages of marijuana over dronabinol, with no risk of infection from contaminated marijuana, or of harm from combustion products in the smoke. The fact that a very similar marijuana delivery system has long been used ("hash oil," which is illegal but clearly does deliver the drug in a way acceptable to users) shows that developing a pharmaceutical heat-and-inhale delivery system would not be difficult technically. And the existing approval of dronabinol provides legal precedent; only the drug formulation and delivery would be different. Then the medical marijuana issue might ease, to the benefit of both sides. The California and Arizona propositions may have opened the door politically to practical research, which would ask why some patients need marijuana and how else their needs might be met.

AIDS Treatment News  28 - Page Index

A 28-page index to AIDS Treatment News from January 1994 through December 1996 will be mailed automatically to all who currently subscribe at the regular (non-subsidized) rates, probably early in January. (Those who are now paying a subsidized rate -- $45 per year or less -- who have ever previously subscribed at the full rate will also receive the index without charge.) This index differs from others in that every entry includes the title and date of the article, so that you can tell immediately which ones are likely to be important for you. Also, every entry represents the judgment of our editor that the article should be included under that particular heading. We developed this format in-house to be the most useful reference for AIDS Treatment News. An online version of this index will be available at the AIDS Treatment News back-issue site, http://www.immunet.org/atn. A much shorter index for 1996 only appears below.

AIDS Treatment News Index, 1996 2003 | 2002 | 2001 | 2000 | 1999 | 1998 | 1997

Topic Issue Numbers 141W94 (protease inhibitor) 240, 239 1592 261, 259, 253 3TC 259, 256, 252, 246, 244, 241, 240, 238 3TC+AZT 238 Abbott Laboratories 243 Abrams, Dr. Donald 257 Access for All 248 acetaminophen 250 ACT UP -- U.S. chapters 238 ACT UP/Golden Gate 247, 246, 243, 238 ACT UP/New York 246 ACT UP/Philadelphia 246 ACT UP/San Francisco 244 ACTG 152 244 ACTG 175 257, 244 ACTG 290 261 activism 260, 258, 254, 246, 244, 238 ADAP (AIDS Drug Assistance Program) 257, 256, 255 ADAP 246, 244, 241 ADAP funding crisis 252 Africa 247 AIDES (France) 258 AIDS Action Council 245 AIDS Benefits Counselors 257, 255 AIDS Treatment News Associates 254 AIDS Treatment News Internet Directory 250 AIDS Vaccine Advocacy Coalition 261 AIDSACT 258 AIDSLINE 242 AIDSWatch (lobbying project) 246 albendazole 260 alpha-lipoic acid 250 alternative treatment research 258 alternative/complementary treatment 249, 247, 246, 243 Amplicor HIV-1 Monitor(TM) 248 antioxidants 250 Antiviral Drugs Advisory Committee-FDA 243 Arizona 259 Arnold, William 252 AVAC 261 azithromycin 249 AZT 259, 257, 244, 238 AZT 300 mg dose 259 AZT+d4T 261 Baltimore, Dr. David 261 Bastyr University 246, 243 benefits 257, 255 bioethics 258 biotin 250 Birmingham conference Nov. 96 259 buyers' clubs 260, 258, 250 buyers' clubs (listed by state) 260 CAESAR study 256, 252 California 259, 253, 246, 244, 241 California Medical Association 261 Californians for Medical Rights 261, 259 Canada 260, 238 cannabis 261 cannabis buyers' clubs 252 cannabis buyers' clubs (Calif. list) 253 Caribbean 258 CD8 cells 238 censorship 249, 240, 238 Center for Natural and Traditional Med 247 Centers for Disease Control 249 CGP 61755 (protease inhibitor) 240 chemokines 238 Chinese traditional medicine 259, 247, 245 chocolate 257 choline 250 CIBA-Geigy Ltd. 240 cidofovir 256, 244 CKR-5 256, 254 clinical trials 257, 245, 244, 240 clinical trials -- design 252 CME (continuing medical education) 250 CMV 244 CMV retinitis 250 CMV retinitis screening 256 CNTM (Center for Natural and Tradit... 247 COBRA 255 cofactor 247 combination d4T+ddI 241 combination indinavir+AZT+3TC 241 combination indinavir+AZT+ddI 241 combination nelfinavir+d4T 242 combination treatment 253, 251, 249, 245, 244, 243, 239 communicable diseases 241 Community Consortium 244 Community Prescription Service 245 computer communication 250, 247 conferences, meetings -- lists 253 confirmatory trials 252 Congress 256, 252 consensus letter 261 consensus recommendations 248 consensus statement 243 contributions 247 Cooper, Sally 258 cost of care 241 CPCRA 007 257, 244 credibility struggles 260 CRI of New England 242 Crixivan see: indinavir cryptosporidiosis 258, 250, 239, 238 Cuba 244 curcumin 242 d4T 259, 254, 242, 241 d4T+AZT 261 d4T+ddI 241 DaunoXome(R) 246 ddC 259, 257, 244, 240 ddI 259, 257, 254, 244, 241 death statistics 260 Delaney, Martin 243 delavirdine 260, 259, 245, 239 developing countries 249, 248, 247 DHEA 252, 242, 239 didanosine see: ddI disability insurance 257 disclosure 247 DMP 266 255 DOXIL 246 dronabinol (Marinol) 261 drug delivery systems 261 drug interactions 244, 243, 239 drug prices 248, 246, 245, 243 drug pricing 257, 256, 254 Duesberg, Dr. Peter 260 early treatment 249 email 258 epidemiology 246 Epstein, Dr. Steven 260 eradication 251 Eradication of HIV conference 249 ethics 258, 252 ethics -- financial disclosure 247 expanded access 255, 245, 239 experience of physicians 242 ExtraMED database 249 FDA 259, 258, 248, 243 FDA advisory committees 260, 244, 243 FDA reform 245 food safety 238 Fortuno, Daniel 255 four-drug combinations 243 Fowkes, Steven 242 funding 256, 247 fusin 254, 247 Gallo, Dr. Robert 258, 238 gamma linolenic acid 250 Gay Men's Health Crisis 243 general assistance 241 genetic resistance to HIV 256, 254 Geneva 261 Getty, Jeff 243 Gilden, Dave 243 Gilead Sciences 248, 244 Glaxo Wellcome 261, 259, 253, 248, 240 glutathione 250 GP-160 245 grassroots organizing 256 GS 504 intravenous 244 Guatemala 244 guidelines for treatment see: standards of care hCG 258 hepatitis B 238 hepatitis C 258 Herzenberg Laboratory 250, 246 HIV 249 HIV suppression 259 HMOs 255, 238 Hoffmann-La Roche 248, 244 hotlines 256 HPMPC 244 human chorionic gonadotropin 258 human growth hormone 254, 243 Hutt, Peter Barton 245 hydroxyurea 259 IAS (International AIDS Society) 247 ICAAC conference 255 IDSA (Infectious Diseases Soc. of Am.) 242 III World Congress of Bioethics 258 IL-2 258 immigration 256 immune-based therapy 258 Immunet 247 IMPURE SCIENCE 260 index 261 indinavir 259, 251, 249, 246, 244, 241, 243, 239 indinavir price 245 indinavir+AZT+3TC 241 indinavir+AZT+ddI 241 information obstacles 241 inositol 250 insurance 257, 255, 238 international 258, 247, 244 International AIDS Society 247 Int'l Conf. (1996, Vancouver) 251, 250, 248, 247, 246, 245 International Conf. (1998, Geneva) 261 Internet 259, 256, 250, 249, 247 interview, Daniel Fortuno 255 interview, Dr. John Kaiser 239 interview, Dr. Peter Piot 258 interview, Dr. Steven Scheibel 253 interview, Kaiya Montaocean 247 interview, Peter Barton Hutt 245 interview, William Arnold 252 Kaiser, Dr. Jon 239 Kaposi's sarcoma 258, 246 Kessler, Commissioner David 245 l-carnitine 250 lamivudine see: 3TC Lands, Lark 250 legal issues 261, 257, 255, 242, 238 letters to the editor 256 Levin, Jules 243 Levy, Dr. Jay 238 liposomal daunorubicin 246 lupus 242 lymph tissue 259 MAC prophylaxis 249 MACS database 246 magnesium 250 managed care 241 mandatory testing 246 marijuana 261, 259, 257, 256, 253, 252 media 247 Medibolics (newsletter) 243 Medicaid 255, 241 MediCal 254 Medicare managed care 257 meeting disruptions 244 Mellors, Dr. JW 248 Montaocean, Kaiya 247 NAC 250, 246, 239 NATAP (National AIDS Treatment Adv...) 245, 243 NATC (Natural, Alternative, Tradit...) 247 National Council for Int'l Health 247 National Institutes of Health 247, 244 NATURE MEDICINE (journal) 248 NCIH 247 needle exchange 239 needlestick 249 nelfinavir 259, 255, 251, 243, 240, 239 nelfinavir+AZT+3TC 240 nelfinavir+d4T 242 neuropathy 250 nevirapine 259, 250, 249 NeXstar Pharmaceuticals 246 NMAC (National Minority AIDS Council) 240 NTZ 258, 250, 239 nutrition 250 OBRA 255 off label 238 Office of AIDS Research 259, 246, 244 online CME 256, 250 outcomes research 246 oxandrolone 243 pathogenesis 247 patient assistance programs 248 PCR (viral load test) 248 pediatric 246 Pelosi, Congresswoman Nancy 256 Pharmacia & Upjohn 240, 239 PhRMA 257, 256 physician experience 242 PI PERSPECTIVE (newsletter) 243 Piot, Dr. Peter 258 PMPA 248 polls 256 Porter, Congressman John 256 POSITIVELY WELL, by Lark Lands 250 press 255, 241 prisoners 240 prognosis 248, 246 progression 238 Project Inform 261, 244, 243 Proposition 200 (Arizona) 261 Proposition 215 (California) 261, 253, 252 protease inhibitor combinations 256, 254 protease inhibitors 258, 251, 246, 245, 244, 243, 242, 241, 240, 239 public opinion 259 public television 259 PWA Coalition 238 PWA Coalition of New York 246 PWA Health Group 258, 246 Qigong 259, 245 reader survey 260 receptors 254 redox 250 Regelson, William 242 reimbursement 243, 241, 238 research policy 249, 244 resistance 241 resistance testing 261 resistance to drugs 254 Retroviruses Conference (1996 Jan-Feb) 242, 241, 240 Retroviruses Conference (1997 Jan) 259, 258, 255 ritonavir 259, 245, 243, 240, 239 ritonavir drug interactions 244 ritonavir+AZT+ddC 240 ritonavir+saquinavir 256, 254, 243 rolipram 242 Ryan White CARE Act 246 San Francisco 238 saquinavir 259, 251, 245, 243, 239 saquinavir new formulation 246 saquinavir+ritonavir 256, 254, 243 satellite meetings (Vancouver conf.) 245 Scheibel, Dr. Steven 253 scholarships 258 SCIENCE (journal) 250 Scondras, David 248 Serono Laboratories, Inc. 254 sinusitis 245 Skolnik, Dr. Paul 242 small rapid trials 249 small simple trials 248 South Africa 244, 240 SSDI 257 SSI 257 Stadtlanders Pharmacy 246, 245, 244, 243 standards of care 259, 251, 248 Stanford University 239 stavudine see: d4T stem cells 256 surveys 260, 246 survival 260, 251, 248, 246, 242, 240 synergy 243 T-20 255 TAG 256 thiamine 250 Thorne, Bill 243 TNF inhibitors 242 tonsils 259 traditional medical practitioners 247 treatment IND 243 TREATMENT ISSUES (newsletter, GMHC) 258, 243 Trials Search (service) 244 triple drug therapy 251 UNAIDS 258 UNIMED Pharmaceuticals, Inc. 258, 239 vaccine 261 VaxSyn 245 viral load 257, 256, 252, 251, 249, 248, 244, 239 viral load seminars 261 viral resistance testing 261 vitamin B12 250 vitamin B6 250 VLAP (Viral Load Assistance Program) 257 VX478 (protease inhibitor) 243, 240 WALL STREET JOURNAL 259 wasting syndrome 243 water supply safety 238 women 261, 239, 238 World Wide Web 250, 247, 243, 242 zalcitabine see: ddC zidovudine 259, 257,244, 238 Copyright 1996 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.