From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: CMV Article in Sentinel
Note: non-commercial reproduction.
Archive-Number: 5892
Organization: UCLA, Computer Science Department
Date: Thu, 13 Aug 92 15:56:10 PDT

The following article appeared printed in the San Francisco Sentinel,  
on Thursday, August 13, 1992.

It is being posted here with the permission of the author Charles 
Caulfield.  
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             STANDARD MEDICAL PRACTICE LIMITED IN CMV TREATMENT 
                                  by
                       Charles R. Caulfield 

  Few things are as frightening to people living with HIV as the 
prospect of blindness caused by Cytomegalovirus. This virus, which is 
known to infect approximately 90l% of gay men, becomes active and causes 
serious symptoms in 44% of all AIDS cases.  According to an April 1992   
report in Treatment Issues,  the monthly newsletter of the Gay Mens' 
Health Crisis in New York, the first symptoms of CMV disease often 
affect the eyes, resulting in a condition called retinitis, which when 
left untreated invariably results in blindness. CMV is viewed as a major 
cause of death in PWAs. 

   So far, only two treatments have been approved in the U.S. for 
treating this condition.  Both of these pose grave problems which 
restrict their use to possibly fewer than half of the people who face 
blindness and death from  this condition. Neither can be used as a 
prophylaxis for CMV disease, and are only approved for use in the 
advancing stages of the illness. Neither drug extends life expectancy 
for longer than a year.

  In light of this information, this article in two parts will discuss 
options for treatment of CMV from both the conventional and alternative 
avenues of medicine. Since so little progress has been made during the 
first decade of this epidemic,  many people  need treatment options now,  
and cannot afford to wait for lengthy clinical trials to materialize.  
For these individuals, sources of further in formation are provided to 
allow further research leading to informed choices. It is imperative 
that any HIV positive individuals experiencing changes in their vision 
report this to their primary caregiver.

   Until late in 1991, the only treatment available was the antiviral 
drug ganciclovir, or DHPG, manufactured by Syntex Pharmaceuticals under 
the brand name Cytovene. It is a nucleoside analog drug costing up to 
$12,000 a year to use. Its side effects, which frequently result in the 
discontinuation of therapy, include severe bone marrow suppression and 
anemia.  It is currently only available in intravenous form, requiring 
daily infusions of the drug through a permanent IV catheter. It 
frequently cannot be used simultaneously with other anti-retroviral 
drugs such as AZT, ddI or ddC, due to bone marrow toxicity, and must be 
used for life. One study of ganciclovir therapy for CMV patients showed 
a relapse rate for recurrence of retinitis symptoms in 54% of the 
subjects after a period of 97 days. (VII Int. Conf on AIDS, abstract 
#W.B.3254, Florence, Italy 1991).

   The newest approved  drug, Foscarnet , marketed by Astra 
Pharmaceuticals , has received  considerable negative press in recent 
days. It appears to have some comparative merit over ganciclovir.  The 
controversy surrounds its $30,000 a year price tag,  which activists 
argue is not justified by the drug's development costs . Foscarnet, a 
phosphate analog drug,  received FDA approval late in 1991, under the 
brand name Foscavir. Its side effects include intractable nausea, 
seizures and kidney toxicity leading to renal impairment in 33% of 
individuals using the drug. In clinical trials,  even though there is 
strong data which suggests that CMV sufferers live up to 50% longer on 
Foscarnet than on ganciclovir, 40% of the patients chose to switch to 
ganciclovir and risk an earlier death rather than suffer with the 
unbearable nausea caused by Foscarnet. ("Eye Drug Prolongs AIDS 
Patients' Lives."  NY Times, October 22, 1991). 

   There are no drugs available which are licensed to prevent the 
development of symptoms of CMV. Some physicians advocate the use of 
Zovirax, the Burroughs Wellcome antiviral, acyclovir, but the results of 
studies on this are conflicting.  The drug's cost is too prohibitive for 
widespread use as a prophylactic measure. 

   From outside the scope of conservative Western Medicine, some 
treatment options have been put forward, although most of them lack the 
pharmaceutical industry backing needed to navigate the drugs through the 
muddy waters of Wall Street and the FDA approval process.  They are all  
reasonably affordable by most people, and are generally assumed to be 
safe.  There is a strong case to be made for each of them, but they have 
not been subjected to rigorous, controlled testing.   The first of these 
has a fairly large following in the underground treatment community. 
Butylated Hydroxytoluene (BHT) is a food additive most of us have 
consumed in fairly large quantities on a daily basis since we were 
children. The phrase, "BHT added to retard spoilage" appears on millions 
of bread and cereal packages in the U.S. every day.  Its antiviral 
applications have been the subject of investigations since the 1970s. In 
laboratory tests it has been shown to be effective in blocking the 
replication of lipid coated viruses, which include CMV, Herpes viruses, 
Epstein-Barr and others. It is not clear how the substance achieves this 
effect. It is believed to cause damage to the lipid envelope of viruses, 
inactivating their ability to replicate. There was some interest in 
using this as a treatment for HIV in the 1980s, but this subsided when 
it was allegedly proven ineffective against HIV by tests done at the 
National Cancer Institute.

   BHT's usefulness in treating CMV infection has not come under any 
formal investigation in recent years.  Results of it's specific action 
against cytomegalovirus were reported  in The Journal of Infectious 
Disease, and the journal Science.,   in the late 1970s. The chemical was 
popularized as a treatment against herpes virus infections by Pearson 
and Shaw in The Life Extension Companion,  published in 1984.

  Even though there has not been any academic research into use of BHT 
as an antiviral drug in human medicine, many people report arresting the 
progression of CMV retinitis by way of it's use. It is readily available 
in health food stores and at chemical supply houses at a cost of 
approximately $20.00 per year. It cannot be used by people who drink 
alcohol, and may be harmful if used in pregnancy. It is theorized that 2 
to 3 grams per day will prevent progression of CMV disease, as well as 
herpes and possibly shingles. The drug is fat soluble, and is usually 
used by dissolving the powder in a teaspoon of olive oil and allowing it 
to stand overnight before consuming. One should start at 1/4 of the 
maximum dosage to insure that no allergy exists, building up gradually 
over several days to the desired dose. It is strongly suggested that 
individuals considering using this treatment do further research beyond 
the scope of this article, to fully familiarize themselves with the pros 
and cons of this treatment.

  An organization exists for the purpose of distributing information on 
the medical uses of BHT. They a publish a book entitled, Wipe Out Herpes 
with BHT available for $6.35 postage and handling included. Also 
available is their newsletter, Forefront, published six times a year at 
a cost to subscribers of $18.00., which keeps it's readers up to date on 
the most current developments in BHT  and other alternative treatments. 
For book purchases, newsletter subscriptions or general inquiries, one 
may contact:

MegaHealth Society

P.O. Box 60637

Palo Alto CA 94306

(415) 949-0919

Next week The Sentinel will report on other treatment alternatives for 
CMV management. 
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