From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: ATN #159
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6232
Organization: unspecified
Date: Sun, 27 Sep 92 11:23:15 PDT

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J O H N   J A M E S  writes  on  A I D S 
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Copyright 1992 by John S. James; 
permission granted for non-commercial use. 

AIDS TREATMENT NEWS Issue #159, September 18, 1992 
   phone 800/TREAT-1-2, or 415/255-0588 

CONTENTS:  [items are separated by "*****" for this display] 

d4T (Stavudine) Background 
Alpha-APA:  New Anti-HIV Compound 
Yohimbine:  Accidental Discovery As Fatigue Treatment? 
ICAAC Conference October 11-14, Anaheim, California 
International AIDS Organizations Develop from VIII 
   International Conference 
AIDS TREATMENT NEWS Developing International Treatment 
   Newsletter 
Proposed Budget Cuts Threaten "San Francisco Model" 
From the Editor 

***** 

     This issue singles out three drugs for attention, for very 
     different reasons: 

     d4T (stavudine) is a close relative of AZT, but it may be 
     somewhat more effective and less toxic.  It is important 
     because it will soon be more widely available, under a 
     "parallel track" protocol, for persons who have failed 
     treatment with AZT and with ddI.  (Persons who are now using 
     AZT may be able to volunteer for a separate program, a 
     clinical trial comparing d4T and AZT, which is currently 
     running at sites throughout the U. S., and at sites in 
     Europe.) 

     Alpha APA (a class of anti-HIV drugs, of which one member, R 
     89439, has been selected for clinical development) is at a 
     much earlier stage of research; it has completed animal 
     toxicity tests, and the earliest safety tests in humans. 
     The next trials will be only in Europe, not in the U. S. 
     This drug deserves attention because it has very good 
     laboratory activity against HIV, and also is inexpensive to 
     manufacture, so that it could potentially be used in all 
     countries.  The major possible drawback is that other drugs 
     with a similar mechanism of action have had serious problems 
     with HIV developing resistance; it is not known if that will 
     happen with this drug too.  Alpha APA has been presented at 
     three scientific meetings, but has received little attention 
     so far. 

     The third drug, yohimbine, is not an antiviral; it is a 
     prescription drug with one approved use, treatment of 
     impotence in men.  Recently there have been anecdotal but 
     dramatic reports from a handful of patients that yohimbine 
     relieved serious AIDS-related fatigue which could not be 
     diagnosed as due to any opportunistic infection or other 
     known cause.  If this early and unexpected finding is 
     confirmed, the drug might have important use in improving 
     quality of life for some patients, and might even help in 
     understanding the pathogenesis of AIDS.  More research is 
     needed, and community-based as well as academic research 
     groups could contribute. 

***** d4T (Stavudine) Background 

by John S. James 

     d4T (also called stavudine; its chemical name has been 
spelled in various ways, including 2',3'-didehydro-2',3'- 
dideoxythymidine) is important now for two reasons: 

          * A "parallel track" trial, run by d4T developer 
     Bristol-Myers Squibb, will soon make this drug available to 
     persons who have failed both AZT and ddI, and therefore have 
     no approved HIV treatment options; and 

          * Results of early trials, as well as the impressions 
     of researchers and others who have worked with d4T, suggest 
     that this drug might be somewhat better than either AZT or 
     ddI as a single agent.  If so, d4T could be a modest but 
     important improvement in AIDS/HIV treatment.  But the 
     benefits are limited, as the drug does not totally stop 
     disease progression.  Like AZT, ddI, and ddC it can only 
     prevent infection of new cells, but cannot reduce viral 
     activity in chronically infected cells. 

     [Comment:  d4T would be less important today if any truly 
good AIDS treatment were on the near horizon.  Where we are now 
in HIV treatment can be illustrated by comparison with the 
history of other diseases.  For example, it has recently been 
noted that treatment of the opportunistic infection MAC is where 
treatment of tuberculosis was several decades ago -- in that one 
good drug had been discovered (clarithromycin for MAC, 
streptomycin for TB), although clearly other drugs would be 
needed too.  Today we are not yet at that stage in treating HIV, 
as we only have poor to mediocre drugs:  AZT, ddI, ddC, and now 
(an anticipated improvement, but still in the mediocre-at-best 
category) d4T. 

     We suspect that the most likely source of a good drug today 
would be protease or tat inhibitors.  But these are moving slowly 
-- mainly, it seems, because of technical difficulties in the 
former case, and corporate politics in the latter.] 

     Until better drugs are developed, the available improvements 
in second-rate technology (in this case, blocking of reverse 
transcriptase, which will not work for chronically infected 
cells) will be important.  For this reason we have prepared an 
overview of d4T itself, the ongoing phase II/III trial, and the 
parallel-track program which is expected to begin soon. 

d4T 

     d4T is a close chemical relative of AZT, but it does not 
have the azido group (three nitrogen atoms) in the molecule.  In 
test-tube studies with AZT, and in animal studies with other 
retroviruses, d4T often worked less well than AZT. 

     But d4T may make up for this disadvantage by being processmore efficiently in human cells.  Both drugs enter the cell 
unchanged, but are not active against HIV until they are 
chemically converted to a triphosphate form (with three phosphate 
groups added to the molecule) by enzymes within some (not all) 
cells.  A major problem with AZT is that it tends to accumulate 
in the monophosphate form (with only one phosphate group 
attached, instead of three); in this form it is ineffective and 
may be harmful.  d4T is converted much better to the 
triphosphate. 

     d4T has very good oral bioavailability; and unlike ddI, it 
does not need a buffer to protect it from stomach acidity. Like 
AZT, it partially crosses the blood-brain barrier.  And HIV 
strains which have become resistant to AZT are often still 
susceptible to d4T -- potentially an important advantage of the 
latter drug. 

     d4T has been given to over 250 patients in early trials (not 
counting the almost 400 patients already enrolled in a large 
phase II/III trial now ongoing, who have been randomized to 
receive either d4T or AZT).  The most important findings are: 

          * T-helper cell increases last longer with d4T than 
     with AZT, often lasting for more than a year before 
     returning to baseline.  (The size of the increase is 
     probably larger, too, but we do not have exact comparisons.) 

          * d4T also shows antiviral activity in humans by 
     reducing p24 antigen. 

          * The main side effect is peripheral neuropathy, 
     similar to that caused by ddI or ddC.  Some patients have 
     had elevated liver-function tests.  These toxicities 
     happened most often at higher doses than are currently being 
     used.  We have not heard of any case of pancreatitis caused 
     by d4T. 

          * The maximum tolerated dose of d4T for long-term use 
     is about 4.0 milligrams per kilogram of body weight per day; 
     above this level, toxicities are unacceptable.  The dose 
     which will be used when the drug is approved is still not 
     determined, but it will probably be not far from 1.0 mg/kg, 
     four times lower than what can be tolerated -- probably no 
     less than 0.5 and no more than more than 2.0.  (A much lower 
     dose, 0.1 mg/kg/day, has been tested and found to be too 
     low.) 

          * There is not enough data yet to know whether d4T will 
     work better than AZT or ddI in preventing AIDS progression 
     or death.  (This is what the phase II/III trial should 
     determine.) 

          * d4T has not yet been tested in combination with other 
     antiretrovirals in clinical trials.  But experts suspect 
     that a combination with AZT will probably not work, because 
     AZT would prevent d4T from being effective; using the drugs 
     in alternation might be OK. On the other hand, the 
     combination of d4T and ddI looks good in laboratory tests; 
     see V. Brankovan and others, "Strong synergistic anti-HIV 
     activity of a purine and a pyrimidine nucleoside analog, ddI 
     and d4T," V International Conference on AIDS, Montreal, June 
     4-9, 1989 [abstract # M. CP. 128].  This study found that 
     the 50 percent effective concentrations were 5 and 32 uM 
     respectively for d4T and ddI, but only 0.2 uM for the 
     combination; in addition, the toxicity was not synergistic 
     in this laboratory study.  But in people, both drugs can 
     cause peripheral neuropathy; therefore it would be risky to 
     try them together, except in a carefully monitored 
     scientific study. 

          * "Underground" d4T was available recently, but then 
     the supply dried up, apparently because of disputes among 
     people involved, not because of government interference.  We 
     heard good reports about this d4T, which was used by people 
     without other treatment options.  However, underground d4T 
     is unlikely to be important in the future, because the drug 
     is expensive to manufacture in small quantities, and the 
     parallel track will soon make it available without charge to 
     those who need it most.  And when d4T is approved it will be 
     available to anyone, probably for no more than the 
     underground drug would cost, eliminating the market for an 
     underground version, which no one would use if they could 
     get the pharmaceutical drug instead. 

          * d4T is quite stable, and most of it is excreted 
     unchanged in the urine.  When cost or supply is critical, it 
     might be possible to recycle the drug and provide treatment 
     at a fraction of the price otherwise required. 

Phase II/III Ongoing Clinical Trial 

     A large multicenter trial comparing d4T to AZT is now 
recruiting throughout the United States and in Europe. Volunteers 
must have T-helper counts between 50 and 500 and have received 
AZT for at least six months and currently be tolerating at least 
500 mg of AZT daily; they must not have used d4T, ddI, or ddC at 
any time.  There are also a number of other medical and 
laboratory criteria for entry into this study. 

     This trial has now enrolled about 400 volunteers; it is 
seeking a total of 700.  It has 45 U. S. sites in the following 
cities (list is alphabetical by state and by city within state): 
Tucson, Berkeley, Los Angeles, Sacramento, San Francisco, 
Torrance, Denver, Washington D. C., Ft.  Lauderdale, Miami, South 
Miami, Tampa, Atlanta, Chicago, Indianapolis, Kansas City, 
Wichita, Boston, Baltimore, Charlotte, Durham, Omaha, 
Albuquerque, Bronx, New York, Stony Brook, Philadelphia, 
Pittsburgh, San Juan (Puerto Rico), Charleston, Dallas, Houston, 
San Antonio, Salt Lake City, and Milwaukee. 

     For information about this trial, including locations and 
phone numbers of sites in your area, call the AIDS Clinical 
Trials Information Service, 800/TRIALS-A. 

***** "Parallel Track" d4T Access About to Begin 

     Bristol-Myers Squibb will soon begin a large parallel-track 
program which will provide d4T to persons with advanced HIV 
infection who have no other option for antiretroviral treatment 
because they cannot tolerate (or have failed to respond to) AZT 
and ddI.  Details have not been released, pending final approval 
by the FDA, and some criteria for the program may not yet have 
been determined.  Here is what we have learned so far: 

          * The original proposal called for this program to be 
     open only to persons with T-helper counts of 300 or less; 
     however, there is a strong push to raise this limit to 500. 

          * Patients will be randomly assigned to a high dose 
     (somewhat more than 1.0 mg/kg/day, divided into two daily 
     doses), or a low dose which is half that much.  Dosage will 
     be adjusted by body weight. 

          * Efforts will be made to facilitate use of this 
     program by persons receiving their care in public clinics, 
     as well as those who have private physicians. 

     Physicians who want to receive information about this 
program when it is ready should call the Bristol-Myers d4T 
Information Line, 800/842-8036, 7:30 a.m. to 4:00 p. m. Central 
time. 

***** Alpha-APA:  New Anti-HIV Compound 

by John S. James 

     A drug code-named R89439, one of a class of chemicals called 
alpha-anilino phenyl acetamides (alpha-APA), has been discovered 
as a highly specific anti-HIV-1 agent at the Riga Institute for 
Medical Research in Leuven, Belgium, in collaboration with the 
Janssen Research Foundation in Beerse, Belgium.  It has been 
presented at three scientific meetings so far, including the VIII 
International Conference on AIDS in Amsterdam.  This potential 
treatment is interesting for several reasons: 

          * In laboratory tests it is effective against HIV-1 at 
     very small concentrations, a few nanograms per ml.  It also 
     has an unusually large ratio (about 1 to 50,000) between the 
     concentration effective against HIV and that which is toxic 
     to cells. 

          * R89439 has been through standard animal toxicity 
     tests and has been tested in people, in a few HIV-negative 
     volunteers. It is orally available and will probably need to 
     be taken only once or twice a day; eight hours after taking 
     a single 100 mg dose, blood levels in humans are 30 times 
     the amount needed to inhibit HIV.  No particular toxicity is 
     expected, although toxicity cannot be ruled out.  Laboratory 
     tests suggest that the drug is synergistic when combined 
     with AZT or with ddI. 

          * Some alpha-APA derivatives are relatively easy to 
     manufacture, and could be available in any country in the 
     world. 

     The alpha-APA derivatives act by inhibiting reverse 
transcriptase and are very specific to HIV-1, which suggests that 
resistance may develop to this class of compounds, as it has with 
other drugs that are specifically targeted at the HIV-1 reverse 
transcriptase.  At this time, however, no one knows how serious 
any resistance problem might be. 

     Alpha-APA (R89439) will next be tested in phase I/II trials 
in several European countries. 

(AIDS TREATMENT NEWS article includes structural formula of 
R89439 here.) 

References 

Pauwels R, Andries K, Debyser Z, Van Daele P, Schols D, Janssen 
MAC, Desmyter J, De Clercq E, and Janssen PAJ.  HIV-1 specific 
phenylacetamide derivatives:  A novel class of reverse 
transcriptase inhibitors with potent and selective antiviral 
activity in vitro.  Fifth International Conference on Antiviral 
Research, Vancouver, March 8-13, 1992; abstract published in 
Antiviral Research, Supplement 1, March 1992 [abstract #5, page 
45]. 

Pauwels R, Andries K, Schols D, Van Daele P, Debyset Z, Janssen 
MAC, Vandamme A, De Vreese K, Desmyter J, De Clercq E, and 
Janssen PAJ.  Potent and highly selective HIV-1 specific 
inhibition by a new series of alpha-anilino phenylacetamide 
(alpha-APA) derivatives targeted at HIV-1 RT. VIII International 
Conference on AIDS, Amsterdam, June 19-24, 1992 [abstract # PoA 
2320]. 

Janssen PAJ, Stoffels P, Andries K, Van Daele P, Woestenborghs R, 
Pauwels R, Heykants J, Mesens J, Cauwenbergh G, Desmyter J, De 
Clercq E, and Janssen MAC.  Inhibition of HIV-1 by a new series 
of alpha-anilino phenyl acetamide (alpha-APA) derivatives.  VIII 
International Conference on AIDS, Amsterdam, June 19-24, 1992 
[abstract # PoB 3020]. 

***** Yohimbine:  Accidental Discovery As Fatigue Treatment? 

by John S. James 

     Yohimbine is a chemical found in the bark of the Corynanthe 
johimbe tree and in certain other plants; in the U. S., yohimbine 
is available as a prescription drug approved for treating 
impotence in men.  Recently we interviewed two persons with AIDS 
or HIV, and a physician who is treating one of them and two 
others, about their successful use of yohimbine to treat severe, 
long-lasting fatigue for which no specific cause could be found. 
The effect of the drug was rapid and dramatic, leading to a major 
improvement in quality of life.  Both persons we interviewed 
discontinued yohimbine after two to three months, for varying 
reasons; one of them has since restarted the treatment. 

     Physicians would not have expected yohimbine to be helpful 
in treating fatigue.  A recent computer search, for example, 
found 3,255 articles, letters, etc.  published in medical 
journals between 1985 and 1992 which mention yohimbine; but only 
one of these references mentions fatigue, and that did not relate 
to the yohimbine but to another drug used in that particular 
study.  In addition, there are no references to yohimbine on the 
AIDSLINE file, suggesting that little or nothing has been 
published concerning its use in AIDS. (AIDSLINE, published by the 
U. S. National Library of Medicine, is an online database which 
includes many conference abstracts as well as selected abstracts 
and other information from over three thousand medical journals.) 
Most of the articles on yohimbe describe its use in basic 
research, not as a drug. 

Interviews 

     We first heard about yohimbine in a January 9, 1992, letter 
from a person with AIDS.  He had been taking Yocon (one of 
several yohimbine brands available) for one week.  He had taken 
the drug for impotence and was not sure if it had had any effect 
on that, but "it has changed my life in a big way regarding the 
fatigue I had been experiencing [since a recent case of MAC, 
which had been treated successfully].  My productivity has more 
than doubled...I haven't felt this well since the fall of 1987 
before I began to feel ill, and was almost devastated by 
simultaneous PCP and TB in January 1988." 

     We were unsure what to do with this information, since we 
could not publish it without confirmation.  We decided to wait to 
make sure the drug was still working weeks or months later.  We 
temporarily lost contact with the patient, but reached him again 
in early September.  He had continued to feel good until March, 
when he became depressed, and was diagnosed with toxoplasmosis. 
He stopped using yohimbine during the toxoplasmosis treatment, 
and started again about six weeks ago, reporting that the drug 
still works; he is "feeling incredibly well" and plans to spend 
most of the winter in Europe.  "I don't see death in front of me 
like I used to." 

     We asked about his general health.  Five years ago his T- 
helper count had been 6; except for a temporary rise to about 60 
after starting AZT, it has been near zero for five years. Still, 
he "looks perfectly healthy...I don't know what has been keeping 
me going."  He has been taking acyclovir and pentoxifylline 
"since the beginning"; he is seeing a leading AIDS specialist and 
"takes all the pills every day."  He is on prophylaxis for 
pneumocystis, TB, and MAC, and also is taking testosterone and 
Marinol among other medications.  He asked his endocrinologist (a 
different physician) for the yohimbine, and was prescribed it 
when that doctor did not see any harm in trying the drug. 

     Our second report on yohimbine and fatigue came from a 
patient of Marcus Conant, M. D., in San Francisco; he is also a 
friend of one of the staff of AIDS TREATMENT NEWS. He had had 
serious fatigue for four to five months, and was able to work 
only six-hour days (instead of his usually 10 to 12), and then do 
little else but sleep.  All attempts to diagnose the fatigue were 
unsuccessful.  Dr. Conant had heard about yohimbine and fatigue 
"through the grapevine," and suggested trying it after 
investigating the drug and finding no reason not to.  After 
starting yohimbine, the patient was back to his baseline energy 
level almost immediately, and for two to three months had no side 
effects.  But then he started getting "a different kind of nausea 
and headaches, occasional agitation," so he stopped the 
yohimbine.  (A week later Dr. Conant's office called to recommend 
that he go off the drug for a time and then re-evaluate the 
treatment, because there been off the drug now for a month and a 
half, and some fatigue has returned, although it is not as bad as 
before. His T-helper count and blood work are the same as before 
he started yohimbine. 

     This patient has had no AIDS-defining illness.  His T-helper 
count has been very stable at around 230-250 -- except for one 
spike, a rise of about 75 one month after starting yohimbine. 
The rise did not last, however; his count had gone down again to 
its usual value by the next test. 

     He summarized his use of yohimbine by saying it had a 
significant impact on his life and health.  "A long period of 
severe fatigue can cause despair, pessimism, and resignation. 
(Yohimbine) catapulted me out of that...I felt better for a 
significant time, and still feel better now."  He said he might 
use the drug again. 

     Next we spoke with Dr. Conant, who has a large AIDS practice 
in San Francisco, and has prescribed yohimbine for fatigue to 
three AIDS/HIV patients so far. 

     Dr. Conant noted that fatigue can have a variety of causes, 
such as infection, very low T-cells, or depression.  He 
emphasized the importance of physicians making sure they have 
ruled out known causes of fatigue.  "The biggest mistake 
(physicians) make is to jump to a diagnosis; then a treatable 
condition may be covered up, when it should have been treated." 

     He said that his patients have reported that yohimbine was 
effective in decreasing fatigue; he cannot determine yet if it 
affected libido.  The usefulness against fatigue seems to dwindle 
after three months.  At this time, Dr. Conant said, he can 
neither endorse nor reject this use of the drug.  "If we continue 
to hear reports of benefits, it will be important to sort out 
what types of fatigue this drug is useful for." 

Cautions, Dose, Availability 

     The Physicians' Desk Reference notes various precautions and 
side effects, and should be consulted before yohimbine is used. 
Particular warnings include not using the drug in persons with 
kidney disease, nor combining it with antidepressants. 

     "Generally, this drug is not proposed for use in females acertainly must not be used during pregnancy" (Physicians' Desk 
Reference, Yocon entry).  We do not know if there is any 
particular danger to women, or if this warning only reflects the 
fact that U. S. testing and approval was for men. Yohimbine has 
been successfully tested in women, for purposes including weight 
loss. 

     The patients who have used the drug for fatigue so far have 
used the standard dose, one tablet (5.4 mg) three times a day. 
The drug is inexpensive. 

     Yohimbine is also contained in a yohimbe tea, which is sold 
in health-food stores and used as an aphrodisiac.  We have not 
heard of anyone trying this tea for fatigue. 

Research Questions 

     If yohimbine is confirmed to be useful in treating fatigue 
(many drugs have a period of early enthusiasm, perhaps due to 
coincidental improvement by patients, but then are abandoned), a 
number of important questions will need answers: 

          * What kinds of patients are likely to benefit?  This 
     research could readily be done by community-based groups. 

          * Could this treatment help in some cases of chronic 
     fatigue which is not AIDS related? 

          * A question for endocrinologists or academic 
     researchers is whether this unexpected effect of yohimbine 
     could help in understanding part of the pathogenesis of 
     AIDS.  This drug has been used extensively in basic research 
     because of its effects in blocking certain receptors; but 
     much of its mechanism of action (especially with the low 
     doses used medically) is not understood.  Sometimes an 
     accidental discovery, especially one which is unexpected, 
     opens new avenues for productive research. 

***** ICAAC Conference October 11-14, Anaheim, California 

     The annual Interscience Conference on Antimicrobial Agents 
and Chemotherapy (ICAAC) will take place at the Anaheim 
Convention Center in Anaheim, California, October 11-14, 1992. 
This technical conference focuses on the development of new 
antibiotics; recent meetings have increasingly covered AIDS. 

     Another meeting, of the Infectious Diseases Society of 
America, is held in conjunction with ICAAC. This year it will 
take place shortly before ICAAC, in Anaheim. 

     This year's ICAAC includes symposia on tuberculosis, 
cytokines, antiviral therapies, antiviral resistance, protease 
inhibitors, prophylaxis in persons with HIV, new antibiotics and 
antifungals, and a joint symposium on AIDS with the Infectious 
Diseases Society of America. 

     For more information, call the American Society for 
Microbiology, 202/737-3600. 

***** International AIDS Organizations Develop from VIII 
   International Conference 

by Dave Gilden 

     The Eighth International Conference on AIDS left many of the 
people who actually have AIDS, or some degree of immune 
deficiency, dissatisfied.  This was true although this year's 
conference organizers went to greater lengths than ever before to 
include community concerns in its agenda and community activists 
in its planning. 

     "The Conference still didn't 'get it.'  Organizers don't 
understand why people with HIV are central to the fight, and we 
remain in a ghetto, never fully integrated," observed Arawn 
Eibhlyn of ACT UP/San Francisco. 

     Moreover, Eibhlyn, noted, "Every year, we get together and 
whine and complain.  There's never a mechanism for an ongoing 
effort.  It will really be a drag to have the same meeting in 
Berlin as we had in Amsterdam, Florence and San Francisco." 

     Perhaps because of the liberal atmosphere, though, 
international grassroots networks sprung up at the conference as 
never before.  They especially aim at making future international 
sessions more useful to people looking for treatment information 
that they can take home and use immediately. 

     Here are four examples of the way activists around the world 
are connecting up: 

          * A pre-existing "Global Network of People Living with 
     HIV/AIDS" was reorganized and reinvigorated, reports Cindy 
     Robins of Toronto, who is president of the network's new 
     management committee. 

     After a tumultuous session with the steering committee for 
next year's conference, in which 100 demonstrators barged into 
the steering committee's meeting during the Amsterdam conference, 
the global network is trying to arrange a more central position 
for people directly affected by the epidemic.  In addition, the 
network is planning another in its yearly series of international 
conferences by and for people living with HIV/AIDS.  Next year's 
event will take place in Acapulco, Mexico in September. 

     Past such conferences have been criticized for their 
haphazard organization; also, they have had few participants from 
the U. S.  Acapulco promises to be different on both counts. 

     The Global Network of People Living with HIV/AIDS is in the 
process of obtaining a central coordinating address.  In the 
meantime, its U. S. representative, Peter Uitdenbosch, can be 
reached at:  813/922-9286.  The address of the local organizing 
committee for the Acapulco conference is:  Sixth International 
Conference for People Living with HIV/AIDS, Queretaro no. 219-H, 
Col. Roma, Mexico, DF 06700. 

          * Women have felt a lack of visibility even at past 
     international meetings of people with AIDS.  Before the 
     official Amsterdam conference, an international pre- 
     conference of 59 women meeting over four days discussed 
     women's particular needs as the epidemic continues.  A new 
     network, the "International Community of Women Living with 
     HIV/AIDS," grew out of that meeting. 

     "There never has been an international organization of 
women, but our issues won't be addressed if we don't link up. 
The compassion and commitment [at the preconference] was 
incredible.  This will be a great resource for women," said 
Sharon Lund, the network's West Coast representative. 

     Besides trying to send material aid directly to HIV-positive 
women in poorer countries, the network will function as an 
information exchange on treatment as well as reproductive, family 
and psychosocial issues.  It will also set up women's gatherings 
before future international AIDS conferences. 

     The International Community of Women Living with HIV/AIDS 
can be contacted by leaving a message for Sharon Lund in Los 
Angeles (213/624-3448) or Wendi Modeste in Syracuse, NY 
(315/472-6955). 

          * The above women's group is particularly interested in 
     traditional and alternative therapies because they are 
     treatment strategies women around the world can apply "right 
     now."  Many of the traditional herbal pharmacopeias are 
     largely the work of women, and women also function as the 
     planet's chief dieticians and nutritionists. 

     To ensure that basic therapeutic information is 
disseminated, the Center for Natural and Traditional Medicine in 
Washington, D. C. (as well as other groups) pressured 
international AIDS conferences to include a "fifth track" on 
alternative medicine.  Although that effort has not been 
successful, the Center has obtained permission to organize an 
alternative medicine caucus within the International AIDS 
Society, the annual conferences' official sponsor.  The caucus 
will give proponents of alternative, low-tech medical strategies 
more input into conference decisions, helping to ensure that the 
IAS faithfully keeps its promise to incorporate more alternative 
medicine presentations in all the present conference tracks. 

     "The participation this year of people from developing 
countries, women and AIDS activists made for a turning point. 
Scientists now realize that every medical idea at least has to be 
considered," said Kaiya Montaocean, co-director of the Center. 

     The caucus is just establishing itself on a regional and 
democratic basis.  It seeks participation from medical doctors, 
alternative health practitioners, people with AIDS, activists, 
social scientists, legal experts, and others. Those wishing more 
information can contact Montaocean at the CNTM, PO Box 21735, 
Washington, D. C. 20009 (telephone: 202/234-9632). 

     With partners in four Third World countries, the Center has 
also applied to the World Health Organization for funding to 
found the "Healing Roots Network" which would connect traditional 
medicine groups in an anti-AIDS information and training 
exchange. 

          * Finally, here is an idea for a meta-network from ACT 
     UP/New York.  It is meant to link existing networks together 
     and was presented at the official "global town meeting" that 
     took place at the Amsterdam conference. 

     According to Eric Sawyer of ACT UP/New York, the concept is 
to contact existing AIDS networks and hook them together through 
a fax and electronic mail system.  HIVNET, a computer bulletin 
board based in Amsterdam, is coordinating the European component 
of this effort. 

     Such a system would be comparable to the PEACENET computer 
network that has joined together a range of peace and 
environmental activists for some years.  The hi-tech nature of 
the proposed global HIV network will allow for quick and close 
coordination between distant groups when campaigning around 
specific points.  In particular, Sawyer mentioned all the 
concerns raised about the Berlin conference. 

     To join the mailing list or contribute ideas, contact Eric 
Sawyer (attn.:  Global Network Committee) at 135 W. 29th St., 
tenth floor, New York, NY 10003 (telephone:  212/564-2437). 

***** AIDS TREATMENT NEWS Developing International Treatment 
      Newsletter 

     AIDS TREATMENT NEWS has begun a collaborative project with 
the International Gay & Lesbian Human Rights Commission to 
distribute an international edition of the newsletter to 
communities that are not now receiving treatment information. 

     The international edition will be translated into multiple 
languages and distributed free to grassroots organizations, which 
would then distribute the newsletters to people with AIDS, 
doctors, health care providers and researchers.  In its first 
year, a pilot project would target countries with the highest 
AIDS caseload:  Mexico, Brazil, Thailand, Uganda, Zaire, 
Tanzania, Kenya, India, Poland and Rumania. 

     During this first phase, the newsletter staff will seek out 
people working in grassroots AIDS organizations to survey the 
treatment information needs in their communities.  Meanwhile, a 
quarterly version of AIDS TREATMENT NEWS will be distributed to 
meet the immediate need for information.  As we learn more about 
each community, we will change the international edition to 
better reflect those needs. 

     During the first decade of the AIDS epidemic in the United 
States, people with AIDS took pioneering action to inform 
themselves and get involved in their own treatment decisions. 
AIDS TREATMENT NEWS grew out of and helped create that movement. 
Yet information is not reaching people throughout the world, 
despite the global nature of the AIDS pandemic. "In the first 
decade of response to AIDS, remarkable successes in some 
communities contrast dramatically with a growing sense of 
collective, massive global failure," writes Jonathan Mann and 
others, in AIDS in the World 1992. 

     AIDS TREATMENT NEWS periodically receives requests from 
people in other countries who write about the desperate need for 
treatment information.  "We are studying new drugs for AIDS 
treatment and (are) badly in need of the information on this 
field," a researcher from China wrote.  "By chance I read an 
issue of AIDS TREATMENT NEWS edited by you, and like it very 
much.  Would you please send us all sample issues on Compound Q." 

     Preliminary investigation has shown that although 
representatives from countries all over the world attend the 
International Conference on AIDS, vital information does not 
trickle down to grassroots organizations and people with AIDS. 
Also, organizations in Europe currently take AIDS TREATMENT NEWS 
and translate it into German and Dutch for European distribution, 
but organizations in the developing world can seldom afford 
translation and distribution costs. 

     The international edition staff met recently with eight 
doctors from seven countries who are visiting scholars at the 
Center for AIDS Prevention Studies at the University of 
California in San Francisco.  The doctors were supportive of the 
international edition and offered specific advice about what kind 
of information their communities need. 

     In Brazil, one doctor said, clinicians do not have access to 
laboratory work to determine the T-cell counts of their patients. 
Yet drugs produced by U. S. and European pharmaceutical companies 
are prescribed on the basis of those counts.  "When do we begin 
AZT and why?  When do we start PCP prophylaxis?" 

     The doctors said that their communities would be interested 
in breakthroughs in medicine not yet available in their 
communities as well as information that would be immediately 
useful, such as therapies based on nutrition, which can be an 
affordable treatment. 

     By collaborating with the International Gay & Lesbian Human 
Rights Commission (IGLHRC), the project combines the expertise of 
producing an AIDS treatment newsletter with the experience of 
IGLHRC, which has worked for two years at international 
organizing and distribution of HIV prevention materials 
internationally. 

     What AIDS TREATMENT NEWS needs most is help in finding 
foundations or other organizations who could fund international 
distribution of treatment information.  If you could help us with 
this project, contact Nancy Solomon at AIDS TREATMENT NEWS 
(415/255-4659 (fax); or P. O. Box 411256, San Francisco, CA 
94141). 

***** Proposed Budget Cuts Threaten "San Francisco Model" 

     Proposed cuts to the San Francisco city health budget could 
destroy what is left of the once highly regarded "San Francisco 
model" of AIDS care, activists and care providers say.  San 
Francisco Mayor Frank Jordan is proposing that up to $25 million 
of the $64 million recently lost to San Francisco (due to the 
California budget crisis) be cut from the Department of Health. 

     Health officials, service providers and activists say the 
cuts will cause "the Manhattanization" of health services in San 
Francisco, meaning that the shortage of services in New York will 
soon be felt here. 

     "Pretty much whatever model we had left is going to be 
decimated by these cuts," said Jerry Windley of the Harvey Milk 
Democratic Club.  "The mayor says he is going to protect the AIDS 
budget.  But there is no way not to cut the AIDS budget [while 
cutting overall health care].  People with AIDS go to the health 
centers.  People with AIDS go to (San Francisco) General 
Hospital.  People with AIDS go to the pharmacy at General." 

     Raymond Baxter, director of the Public Health Department, 
said he is opposed to the cuts but has had to suggest how his 
department would handle the reduction.  He is proposing the 
closure of one of the city's five community health clinics, the 
reduction of 75,000 appointments at San Francisco General 
Hospital, removal of one-quarter of the psychiatric beds at the 
hospital, and massive cutbacks to the department of mental 
health. 

     The cuts would also mean the closure of the Center for 
Positive Care, a one-year-old program that created a "one- stop 
shopping" center for AIDS services in the city. 

     Activists working against the cuts have organized a broadly- 
based City Health Budget Coalition, which has scheduled a 
demonstration for Wednesday, Sept. 23, at 5:30 p. m.  at City 
Hall, and will give public testimony to the Finance Committee of 
the Board of Supervisors later that evening, and to the full 
board on Saturday.  For more information, call Alex Vitale at the 
Coalition on Homelessness, 346-3740. 

***** 

AIDS TREATMENT NEWS 
Published twice monthly 

Subscription and Editorial Office: 
   P. O. Box 411256 
   San Francisco, CA 94141 
   800/TREAT-1-2  toll-free U. S. and Canada 
   415/255-0588 regular office number 
   415/255-4659 fax 
Editor and Publisher: 
   John S. James 
Medical Reporters: 
   Jason Heyman 
   John S. James 
   Nancy Solomon 
Reader Services and Business: 
   David Keith 
   Thom Fontaine 
   Tadd Tobias 
   Rae Trewartha 

Statement of Purpose: 
AIDS TREATMENT NEWS reports on experimental and 
standard treatments, especially those available now.  We 
interview physicians, scientists, other health 
professionals, and persons with AIDS or HIV; we also 
collect information from meetings and conferences, 
medical journals, and computer databases.  Long-term 
survivors have usually tried many different treatments, 
and found combinations which work for them.  AIDS 
Treatment News does not recommend particular 
therapies, but seeks to increase the options available. 

Subscription Information:  Call 800/TREAT-1-2 
   Businesses, Institutions, Professionals:  $230/year. 
   Nonprofit organizations:  $115/year. 
   Individuals:  $100/year, or $60 for six months. 
   Special discount for persons with financial difficulties: 
   $45/year, or $24 for six months.  If you cannot afford 
   a subscription, please write or call. 
   Outside North, Central, or South America, add air mail 
   postage:  $20/year, $10 for six months. 
   Back issues available. 
   Fax subscriptions, bulk rates, and multiple subscriptions 
   are available; contact our office for details. 
   Please send U. S. funds:  personal check or bank draft, 
   international postal money order, or travelers checks. 
   VISA, Mastercard, and purchase orders also accepted. 

ISSN # 1052-4207 

Copyright 1992 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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Newsgroups: sci.med.aids