From: Billi Goldberg <bigoldberg@igc.org>
Subject: ATN #148
Note: non-commercial reproduction.
Archive-Number: 4823
Organization: UCLA, Computer Science Department
Date: Wed, 8 Apr 92 08:59:52 PDT

&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& 
J O H N   J A M E S  writes  on  A I D S 
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& 
 
Copyright 1992 by John S. James; 
permission granted for non-commercial use. 
 
AIDS TREATMENT NEWS Issue #148, April 3, 1992 
   phone 800/TREAT-1-2, or 415/255-0588 
 
CONTENTS:  [items are separated by "*****" for this display] 
 
Passive Hyperimmune Therapy (Passive Immunotherapy):  New Data 
Released, California Approval Possible 
International AIDS Conference:  Satellite Meetings 
Anti-Drug Politics Impede Medical Use of Marijuana 
Announcements: 
   Alternative Treatments:  San Francisco Forum, April 18 
   Meet Your Local CongresspersonsQHelp Fund AIDS Research 
and Care 
   Help Wanted:  AIDS TREATMENT NEWS Needs Marketing/Outreach 
Coordinator 
 
***** Passive Hyperimmune Therapy (Passive Immunotherapy): New 
Data Released, California Approval PossiblE 
 
by John S. James 
 
     At a press conference on March 23, HemaCare Corporation, a 
small blood-products company in Southern California, released 
preliminary six-month results from its one-year clinical trial of 
passive hyperimmune therapy (also called passive immunotherapy) 
in persons with AIDS.  Because the company had to be conservative 
in its interpretation, and because it did not release supporting 
details at this time, the importance of the report has not been 
widely understood.  The HemaCare results, which are consistent 
with those of other studies, confirm once again that this 
treatment is highly beneficial for some patients, and almost 
certainly should be available as a treatment option. 
 
     This article examines the new report in the context of 
previous published studies  of passive hyperimmune therapy, and 
also examines related treatments to see where this therapeutic 
approach may lead in the future. 
 
Background:  What Is Passive Hyperimmune Therapy 
 
     In passive hyperimmune therapy (PHT, also called passive 
immunotherapy, or PATH), blood plasma is taken from donors who 
are HIV-positive but unusually healthy, and whose plasma has been 
found to have high levels of neutralizing antibodies (those which 
prevent the growth of HIV in laboratory tests). The plasma is 
usually pooled from several such donors, so that it is likely to 
contain antibodies effective against many strains of the virus. 
The pooled plasma is sterilized chemically to kill HIV and any 
other disease-causing organisms.  The treated plasma is then 
infused into persons with AIDS who have lost their own ability to 
produce protective antibodies.  In the recipient, these 
antibodies can last for several weeks; the current HemaCare study 
gives the infusion treatment once per month. 
 
     Donating the plasma is not believed to cause any harm, as 
the effective antibodies are quickly replaced; donation, in fact, 
often appears to be beneficial, as the body is stimulated to 
produce more antibodies and the levels rise to be higher than 
they were originally.  Only blood plasma is donated; the blood 
cells are separated by a process called plasmapheresis and 
returned immediately to the donor, allowing the plasma collection 
to be done more frequently than regular blood donations. 
 
     The most challenging steps in passive hyperimmune therapy 
are: 
 
     (1) Identifying the best plasma donors.  This step is partly 
an art as well as a science, since at this time there are still 
many unknowns about which antibodies are most important in 
controlling HIV infection. 
 
     (2) Sterilizing the plasma.  It is important to be sure that 
HIV in the donor's plasma is killed, to avoid re-infection with a 
different strain of the virus.  But this must be done in a way 
that does not destroy the useful antibodies.  As a safety check, 
every lot should be cultured to confirm that the virus has been 
killed; and the plasma should be processed in facilities meeting 
the standards of good manufacturing practices for 
pharmaceuticals. 
 
     (3) Setting up and administering the process.  Regulations 
require that dedicated equipment and facilities be used to 
process HIV-positive blood, to avoid any chance of accidental 
contamination of other blood.  If the treatment comes into wider 
use, community support will be needed to help find donors.  And 
the treatment is inherently expensive, because it is labor- 
intensive and requires skilled medical specialists. 
 
Background:  Other Related Therapies 
 
     * This treatment is called passive hyperimmune therapy in 
contrast to vaccines, which stimulate the body to actively 
develop its own immunity.  In PHT, the antibodies are provided; 
the body does not need to make its own. 
 
     * Passive immunization with antibodies derived from human 
blood is widely used in medicine to prevent or treat infections 
other than HIV.  Usually the whole plasma is not given; instead, 
the antibodies are extracted, and given as a product called 
intravenous immune globulin (IVIG).  Several brands of IVIG are 
approved in the United States for prescription use; they may be 
useful in some cases to help persons with AIDS, especially 
children, resist various infections.  IVIG appears to be 
underused in AIDS treatment, primarily because it is expensive. 
 
     IVIG contains no antibodies against HIV, since for safety 
purposes the blood used to prepare it is carefully selected to be 
HIV-negative; therefore IVIG may help to fight opportunistic 
infections, but not HIV itself.  Sometimes the supplier of IVIG 
can select from a lot which happens to have a higher than average 
activity against a certain infection, such as CMV, which the 
physician wants to treat. 
 
     * A form of IVIG especially made to have high anti-CMV 
antibodies, called CMV-IVIG, was approved by the FDA on April 17, 
1990 for certain kidney transplant patients.  This drug was 
developed as an orphan product by the state of Massachusetts, and 
distributed by the American Red Cross, Northeast Region.  Because 
of supply problems, the drug was restricted to the patients 
considered most likely to benefitQ those without CMV who received 
kidneys from CMV-positive donors.  As of two years ago, the 
supply problems were expected to last about nine months.  We have 
not heard of this treatment being tried for persons with AIDS- 
related CMV. 
 
     * An IVIG preparation specifically made with anti-HIV 
antibodies, called HIVIG, may be tested as an HIV treatment, at 
least in infants, or tested to see if it can prevent mother- 
infant transmission of HIV during pregnancy.  This treatment 
appears to be essentially equivalent to passive hyperimmune 
therapy.  HIVIG is only made by Abbott Laboratories, however, and 
that company seems less than enthusiastic about developing it. 
 
     * The ultimate future direction of passive immunotherapy for 
HIV and other diseases is likely to be in monoclonal antibodies. 
These are not extracted from human blood, but are produced by 
cells which are created in the laboratory by genetic engineering 
and other techniques.  An anti-CMV monoclonal antibody is 
currently in clinical trials. 
 
     The development of anti-HIV monoclonal antibodies may be 
more difficult because of uncertainty about which antibodies are 
beneficial and clinically important.  In the laboratory the wrong 
antibodies can actually increase viral infection; this has not 
been a problem in passive hyperimmune therapy trials, however. 
There is intense research interest in learning which antibodies 
are effective, since this information is important not only for 
developing antibodies for treatment, but also for developing 
vaccines, and for preventing HIV transmission during pregnancy. 
The AIDS community must pay more attention to developments in 
monoclonal antibodies around the world, to make sure that 
research and development move forward as fast as technically 
feasible. 
 
Passive Hyperimmune Therapy:  The HemaCare Study 
 
     HemaCare Corporation had not previously run clinical trials, 
but it did have experience well suited for a study of passive 
hyperimmune therapy.  The company specializes in therapeutic 
hemapheresis, a process of "separating the blood into its 
components, removing unwanted substances, and returning the other 
components to the patient."  This therapy is used in at least 30 
different diseases; HemaCare provides mobile units which travel 
to hospitals and administer the treatment at the patient's 
bedside.  The company also sells platelet concentrates and other 
blood products from healthy donorsQas well as plasma which 
contains rare antibodies.  It had this experience before becoming 
involved in AIDS. 
 
     The current placebo-controlled study has 219 volunteers with 
ARC or AIDS.  They are randomized to three groups:  full-dose 
(500 cc of plasma once a month), half dose, and placebo.  Although 
six-month interim data was reported, the trial is still 
continuing. 
 
     The most important result so far is that there were only a 
third of the deaths in the full-dose group as in the placebo 
group.  However, there have not been enough deaths in the study 
for this result to reach the level of statistical proof; it only 
reached the statistical significance level of p=0.1276 (meaning 
that if the treatment were useless, the odds would be one in 
eight that a result this good or better could have occurred by 
chance alone).  In most medical research, the statistical 
significance must be p<.05 (meaning that the odds are less than 
one in 20 that the result could occur by chance alone) for a 
finding to be taken seriously.  As a result, the company could not 
emphasize this survival difference, and its significance has been 
underreported and underrated. 
 
     What is widely overlooked is that the value of p<.05 is an 
arbitrary level which has become customary, not a gold standard 
of truth.  A result which fails to reach that level because there 
were too few volunteers (or too few deaths) in a trial should not 
be ignored as if it did not exist.  Instead, it should be 
considered together with other information which is available 
from the same or other trials.  And when the available information 
on passive hyperimmune therapy is considered togetherQnot broken 
up into pieces which are each thrown away because no piece by 
itself is conclusiveQit provides considerable confidence that 
this treatment can provide substantial benefit to persons with 
AIDS, including survival benefit. 
 
     The six-month data did show statistically significant 
changes in T-helper counts, and in levels of beta-2 
microglobulin, in those receiving full dose compared to placebo. 
There were also fewer opportunistic infections with full dose 
than with placebo, although this change was not statistically 
significant at this time.  The treatment may have worked best in 
patients who started with T-helper counts over 50.  The trial is 
continuing, so more results should be available in about six 
months. 
 
     Side effects were minor.  Over 1300 infusions have been 
given (counting treatment and placebo groups together); and none 
of the more than 200 volunteers has had to discontinue treatment 
due to toxicity. 
 
     There was also a large drop in p24 antigen in the full-dose 
group.  But this measurement may be hard to interpret in studies 
of passive hyperimmune therapy, since the infused antibodies may 
simply combine with the p24 antigen, directly affecting what is 
being measured without necessarily helping the patient. 
 
Other Studies 
 
     * The most recently published study of passive hyperimmune 
therapy was conducted by researchers at the Hospital Necker in 
Paris; it was reported in French in May 1991 (1) and in English 
in February 1992 (2).  This study randomized 18 patients to 
either an experimental group, to receive plasma with high levels 
of antibodies against HIV, or to a control group given plasma 
from HIV-negative donors, which would not have any antibodies 
against HIV; the treatment was given every two weeks.  Both 
groups also received AZT, and conventional opportunistic 
infection (OI) prophylaxis.  The experimental group had a greatly 
reduced number of opportunistic infections compared to the 
control groupQtwo vs eight OIs, a difference which is 
statistically significant. 
 
     But when the treatment was stopped at the end of the study, 
the p24 antigen, which had become undetectable, rose to higher 
than its original value, and was correlated with severe clinical 
deterioration.  This rebound effect suggested that it may be 
dangerous for persons with severe immune deficiency to stop 
passive hyperimmune therapy unless a similarly effective 
treatment can be substituted, "as virologic relapse may be 
explosive and poorly tolerated." 
 
     * The most important work on passive hyperimmune therapy has 
been published by the group headed by Abraham Karpas, M. D., of 
Cambridge University, who is generally credited with developing 
this technique as an AIDS therapy.  Karpas and others published a 
series of papers starting in December 1988 (3-8). 
 
     * Another group of researchers, including G. Jackson, M. D., 
at The London Medical College, and colleagues at the University 
of Illinois College of Medicine and at Abbott Laboratories, 
published early studies of this treatment in several patients 
(9-11). 
 
     * A larger trial has been conducted at the Bronx Veterans 
Administration Hospital in New York.  Results have not been 
published, however. 
 
Passive Hyperimmune Therapy:  A Brief History 
 
     PHT for AIDS is not new.  It was first tested in patients 
over five years ago.  Three years ago there was a large, active, 
and enthusiastic patient-activist movement, especially in San 
Francisco, to support testing and availability of this treatment. 
AIDS TREATMENT NEWS listed PHT as one of the most important new 
AIDS treatments to watch during 1989 (issue #72, January 13, 
1989). 
 
     A brief chronology of early public interest: 
 
     * January 23, 1987:  THE TIMES (London) reported that 
Karpas' method was being tested on four patients, who had been 
treated for just over a month.  This trial followed published 
research by Karpas which showed that antibodies were effective 
against HIV in laboratory tests.  The idea of administering 
antibodies this way as a treatment was not new, having long been 
used successfully with other diseases. 
 
     * August 21, 1987:  THE WALL STREET JOURNAL reported that 
Medicorp, a Montreal company which now holds patent rights to 
passive hyperimmune therapy and licensed the method to HemaCare 
for its current study, was planning to begin a trial at two 
hospitals in London, and at a Veterans Administration hospital in 
New York.  A spokesperson for the U. S. National Institutes of 
Health expressed the usual skepticism, saying that the treatment 
had "not much rationality for AIDS, because we don't know the 
function of antibodies, especially since many infected people 
with antibodies in their blood often go on to develop the disease 
anyway." 
 
     * June 15, 1988:  Dr. Jackson's group reported evidence of 
clinical improvement with this treatment, in a talk at the IV 
International Conference on AIDS in Stockholm. 
 
     * August 1988:  The AIDS / HIV EXPERIMENTAL TREATMENT 
DIRECTORY of the American Foundation for AIDS Research (AmFAR) 
published a section on passive immunotherapy, briefly reviewing 
the results to that time. 
 
     * December 1988:  THE NEW YORK TIMES reported encouraging 
indications from studies by Jackson's group (10) and by Karpas' 
group(8). 
 
     * February 6, 1989:  An article by Tim Campbell in the 
Minneapolis, Minnesota GLC VOICE reported that the U. S. Food and 
Drug Administration (FDA) had approved HIVIG for human trials, on 
January 27 of that year.  The article discussed the history of 
the development of this drug, and suggested that it might eclipse 
AZT as the treatment of choice. 
 
     * February 1989:  The first issue of PATH PROJECT NEWS, a 
newsletter of the Passive Immunotherapy Foundation (often called 
the PATH Foundation), reported that California physicians hoped 
to obtain approval to begin a study of passive hyperimmune 
therapy "within two to four weeks, and to begin screening donors 
soon afterward." 
 
     * March 10,1989:  AmFAR and the Pharmaceutical Manufacturers 
Association sponsored a discussion by invited experts on passive 
hyperimmune therapy; a report appeared in the AIDS / HIV 
EXPERIMENTAL TREATMENT DIRECTORY.  The meeting focused on 
producing a more standard product for future research and 
possible use, and it suggested designs for future studies. 
 
     * December 1989:  The fourth issue of PATH PROJECT NEWS 
reported that HemaCare was recruiting both donors and recipients 
for what was then expected to be a 100-patient study. 
 
     In the last two years there has been little public interest 
in passive hyperimmune therapy.  The reason is simply that there 
is no way people could get the treatment.  The plasma cannot be 
obtained by buyers' clubs or guerilla clinics; preparation of the 
plasma is too complex and exacting to be done safely in the 
average physician's office.  Regulatory and commercial obstacles 
continually impeded the development of this therapy. 
 
     Little if anything would have happened in the United States, 
except for the fact that California can approve its own clinical 
trials without the approval of the FDA, provided that the drug 
being tested is manufactured entirely within California.  Since 
the plasma used in the HemaCare trial is collected and processed 
without ever crossing state lines, the California Food and Drug 
Branch (FDB) was able to approve this trial.  As a result, 
passive hyperimmune therapy may be approved only in California. 
(Since the treatment is given only once a month, others could 
presumably come to California for it.) 
 
     HemaCare plans to apply to the FDB for a "treatment IND" to 
allow it to provide passive hyperimmune therapy to up to one 
thousand additional patientsQbefore full approval, which would 
presumably come at the completion of the trial.  The company 
could not provide this treatment without charging enough to at 
least cover its costs.  It does not yet know what its costs will 
be when the plasma is collected and processed on a larger scale. 
 
     The treatment IND will also require community support to 
help in recruiting HIV-positive donors.  Only a minority of 
persons with HIV have the best antibodies and could qualify as 
donors.  Therefore several potential volunteers will need to be 
tested for each donor who is accepted. 
 
     What will be most needed over the next several months is 
community vigilance to see that this project stays on track, and 
that the detours of the past are not repeated. 
 
References 
1.  Lefrere JJ, Vittecoq D, Mattlinger B and others.  Passive 
immunotherapy in AIDS:  transfusion of plasma rich in anti-p24 
antibody (phase I trial).  [English translation of title.] REV. 
FR. TRANSFUS. HEMOBIOL. May 1991:  volume 34, number 3, pages 
199-211. 
 
2.  Vittecoq D, Mattlinger B, Barre-Sinoussi F, and others. 
Passive immunotherapy in AIDS:  A randomized trial of serial 
human immunodeficiency virus-positive transfusions of plasma rich 
in p24 antibodies versus transfusions of seronegative plasma. 
JOURNAL OF INFECTIOUS DISEASES February 1992:  volume 165, number 
2, pages 364-368. 
 
3.  Karpas A, Gray J, Byron N, and others.  Passive immunization 
in ARC and AIDS.  BIOTHERAPY 1990:  volume 2, number 2, pages 
159-172. 
 
4.  Karpas A, Hill F, Youle M, Gray J, and Gazzard B.  Long-term 
follow-up on the effects of passive immunization in patients with 
ARC and AIDS.  Sixth International Conference on AIDS, San 
Francisco, June 20-23, 1990 [abstract S. B. 499]. 
 
5.  Hewlett IK, Epstein JS, Lee SF, and Karpas A.  Evaluation by 
PCR of HIV-1 status of AIDS patients receiving passive 
immunotherapy.  Sixth International Conference on AIDS, San 
Francisco, June 20-23, 1990 [abstract #S. B. 498]. 
 
6.  Karpas A, Hill F, Youle M, Gray J, Oates JK, and Gazzard B. 
Effects of passive immunization in patients with ARC and AIDS. 
J. CHEMOTHER. INFECT. DIS. MALIGNANCIES (Supplement 1) 1989 
[meeting abstract A295]. 
 
7.  Karpas A, Hill F, Youle M, Gray J, Oates JK, and Gazzard B. 
Effect of passive immunization in patients with ARC and AIDS. 
Fifth International Conference on AIDS, Montreal, June 4-9, 1989 
[abstract #W. B. P. 314]. 
 
8.  Karpas A, Hill F, Youle M, Cullen V, Gray J, Byron N, and 
others.  Effects of passive immunization in patients with the 
acquired immunodeficiency syndrome-related complex and acquired 
immunodeficiency syndrome.  PROCEEDINGS OF THE NATIONAL ACADEMY 
OF SCIENCES, USA, December 1988:  volume 85, number 23, pages 
9234-9237. 
 
9.  Hague R, Yap P, Mok JY, Jackson GG, Hargreaves FD, and Coutts 
NA.  Infusion of anti p24 antibody rich plasma in two children 
with persistent HIV antigenaemia -- a pilot study.  Fifth 
International Conference on AIDS, Montreal, June 4-9, 1989 
[abstract # T. B. P. 246]. 
 
10.  Jackson GG, Perkins JT, Rubens M, and others.  Passive 
immunoneutralization of human immunodeficiency virus in patients 
with advanced AIDS.  LANCET, September 17, 1988: pages 647-652. 
 
11.  Jackson GG, Perkins JT, Paul DA, and others.  Passive 
immunoneutralization of HIV p24 antigenemia in patients with 
advanced AIDS by infusion of human plasma.  Fourth International 
Conference on AIDS, Stockholm, June 12-16, 1988 [abstract #3064]. 
 
***** International AIDS Conference:  Satellite Meetings 
 
 The major AIDS conference of 1992, the VIII International 
Conference on AIDS/III STD World Congress, will take place in 
Amsterdam, July 19-24.  As in previous years, many satellite 
meetings sponsored by nonprofit groups and by pharmaceutical 
corporations are scheduled to occur during the Conference, or a 
few days before or after.  Persons making travel arrangements may 
need to know about these meetings early; also, persons who are 
not going to Amsterdam may want to know about the organizations 
sponsoring them, so that they can contact groups with whom they 
share common interests.  [Note: some low-cost air tickets will 
allow the return date (but not the starting date) to be changed, 
with payment of a moderate fee; others will not allow either date 
to be changed.] 
 
     Below we list the non-profit and commercial satellite 
meetings officially recognized by the International Conference as 
of March 31, when this issue went to press.  There will probably 
be other relevant meetings in Amsterdam which are not officially 
recognized by the Conference; we would like to list those too, 
but there is no systematic way to find out about them.  If you 
know of any such meetings, please let us know. 
 
     The AIDS conference this year is combined with the III STD 
World Congress, on sexually-transmitted diseases.  We decided to 
include the whole list, but to give only the contact person, 
affiliation, phone, and fax, even if addresses were available. 
We have found that fax is usually the best means for 
communicating with distant areas, because of its speed and 
reliability, low cost for short messages, convenient use across 
time zones, and the ability to route messages correctly despite 
language differences and to communicate even when persons who 
speak the same language are not in the offices at the same time. 
 
Nonprofit Satellite Meetings 
 
Women with HIV/AIDS -- Workshop, July 14-17.  Anita Bolderhey, 
Dutch HIV Association (HIV VN), 31-20-66-44-076, fax 31-20-66- 
46-689. 
 
Women's Meeting (for researchers, program workers, and 
seropositive women), July 19, 12:30-15:00.  Anita Bolderhey (see 
above). 
 
AIDS Documentation/Information Systems -- Workshop, July 17.  Mary 
Hommes, National Committee on AIDS Control (NCAB), 31-20-69-39- 
444, fax 31-20-69-27-989. 
 
AIDS and Drugs -- Peer Pressure for Risk Reduction, July 20, 
20:00-22:00.  Wouter de Jong/Sam Friedman, NCAB (see above). 
 
Work Stress and Burnout in Health Care Professionals Related to 
HIV/AIDS, July 22, 19:45-22:00.  Emma van Dongen/Wiebe van der 
Woude, NCAB (see above). 
 
European Lesbian and Gay Psychologists, July 17.  Jan Schippers, 
Schorer Foundation, 31-20-66-24-206, fax 31-20-66-46-069. 
 
Network of Sexwork-Related HIV/AIDS Projects, July 18, 10:00- 
18:00.  Jan Visser, Mr. de Graaf Foundation, 31-20-624-7149, fax 
31-20-624-6529. 
 
Asian Solidarity Against AIDS -- Workshop, July 19, morning.  I-S. 
Gilada, Indian Health Organization, Bombay, 91-22-851-9020, fax 
91-22-851-9020. 
 
NARESA Meeting, July 20, evening.  Francesta Farmer, Nairobi, 
254-2-581-080 or 254-2-224-154. 
 
ICASO Latin America Meeting, July 20, evening.  Juan Jacobo 
Hernandez Chavez, Mexico D. F. 52-5-605-8299, fax 52-5-658-3534. 
 
ICASO Africa Meeting, July 20, evening.  As Sy Elhadj, Dakar, 
221-21-9695, fax 221-22-2695. 
 
ICASO Asia/Pacific Meeting, July 20, evening.  Hisham Hussein, 
Kuala Lumpur, 60-3-282-1200 ext. 349, fax 60-3-230-1640. 
 
ICASO Euro Meeting, July 20, evening.  Arne N. Husdal, Oslo, 47- 
2-114-900, fax 47-2-360-269. 
 
Indigenous Solidarity Against AIDS Meeting, July 21, 19:45- 
22:00.  Ron Rowell, National Native American AIDS Prevention 
Center, Oakland, California, 510/444-2051, fax 510/444-1593. 
 
ICASO General Meeting, July 21, evening.  Richard Burzynski, 
Ottawa, 613/230-3580, fax 613/563-4998. 
 
ICASO North America Meeting, July 20, evening.  Richard Burzynski 
(see above). 
 
International AIDS Society Gay and Lesbian Caucus, date to be 
announced.  Greg Herek, International AIDS Society, Dept. of 
Psychology, University of California, Davis, CA 95616. 
 
Culture, Sexual Behavior, and AIDS Prevention, July 24-26.  Han 
ten Brummelhuis, AIDS and Anthropology Group, Department of 
Anthropology, University of Amsterdam, 31-20-525-2504, fax 31- 
20-525-3010. 
 
HIV and Homosexuality -- Workshops: 
 
1.  A Gay and Lesbian Preview of the VIII Conference on AIDS/III 
STD World Congress, July 20, 20:30-22:00. 
 
2.  Towards an International Gay and Lesbian AIDS Policy, July 
22, 20:30-22:00. 
 
3.  HIV Policy, Prevention, Care, and Research:  A Gay 
Perspective, July 23, 20:30-22:00. 
 
4.  HIV Policy, Prevention, Care, and Research:  A Lesbian 
Perspective, July 23, 20:30-22:00. 
 
Mart Simonse, Dutch Association for the Integration of 
Homosexuality -- COC, 31-20-62-34-596, fax 31-20-62-67-795. 
 
AIDS and Primary Health Care:  Implications for General Practice 
and Family Medicine, July 19, morning.  Mr. Ludwig Benecke, 
Benecke Consultants, Amsterdam, 31-20-69-66-349, fax 31-20-69- 
18-446. 
 
Red Cross/Red Crescent AIDS Seminar, July 18 10:00-18:00, July 19 
10:00-15:00, July 20, 18:30-21:00, and July 24(?), 13:30-17:30. 
International Federation of Red Cross and Red Crescent Societies, 
Geneva, 44-21-734-5580, fax 41-22-733-0395. 
 
Symposium on Clinical Topics and Nutrition, July 25, 8:00-17:00. 
Gordon Nary, Physicians Association for AIDS Care (PAAC), 
312/222-1326, fax 312/222-0329. 
 
Neurological and Neuropsychological Complications of HIV 
Infection, July 14-17.  Dr. Peter Portegies, Academic Medical 
Center (AMC), Clinical AIDS Department, Amsterdam Zuidoost, 31- 
20-56-69-111, fax 31-20-55-64-440. 
 
HIV Infection:  The Quality of Life and Its Biopsychosocial 
Aspects, July 16-17.  Dr. S. Christopher W. Mead, Dr. Frits, S. 
A. M., Netherlands Cancer Institute/WHO Quality of Life Center, 
31-20-51-22-482, fax 31-20-61-72-625. 
 
EEC-AIDS Task Force Program in Developing Countries, July 19, 
12:00-16:00.  Dr. Lieve Fransen, EEC Task Force, Brussels, 32- 
2-231-1495, fax 32-2-230-5574. 
 
HIV Nursing:  Caring for the Future, July 19, 10:00-15:00.  James 
P. Halloran, Association of Nurses in AIDS Care, Yardley, 
Pennsylvania, 215/321-2371, fax 215/321-2370. 
 
General Meeting on Street Children, July 21, 20:00-22:00.  Ana 
Filgueiras, SOS Crianca, Rio de Janeiro, 55-21-227-4029 (phone 
and fax). 
 
Working Group:  Street Children, July 22, 20:00-22:00.  Ana 
Filgueiras (see above). 
 
AIDS as a Development Program, July 19, 12:00-14:00.  Walter 
Deville, Health Care and Disease Control, Royal Tropic Institute, 
Amsterdam, 31-20-568-8711, fax 31-20-568-8444. 
 
Drugs and AIDS (in the Netherlands):  Policy and Practice, July 
21, 19:45-22:00.  Ger Rolsma, Project AIDS and the Use of Drugs, 
Dutch Institute for Alcohol and Drugs (NIAD), Utrecht, 31-30-24- 
1200, fax 31-30-31-6362. 
 
Models of AIDS Prevention by Drug Users for Drug Users, July 22, 
19:45-22:00.  Ger Rolsma (see above). 
 
Talking About Risk (Strategies and techniques to help drug 
users), Ger Rolsma (see above). 
 
Empowering People with HIV/AIDS for Self-Advocacy in Developing 
Countries, July 22, 20:00-22:00.  Prof. Dr. I. Wolffers, 
Department of Social Medicine, Free University, Amsterdam, 31- 
20-548-3366, fax 31-20-646-2228. 
 
The Nature of Buddy-Support as Voluntary Work, July 19, 10:00- 
15:00.  Bouko Bakker, Buddy Project, Schorer Foundation, 
Amsterdam, 31-20-662-4206, fax 31-20-664-6069. 
 
"Safe Not Sorry" and "Safe Sex and How to Get It" -- Premier of 
two videos on assertion in preventing HIV infection in sexually 
active women, July 22, 19:45-22:00.  Delys Sargeant, Social 
Biology Resources Center, Melbourne, 61-3-347-8700, fax 61-3- 
347-5892. 
 
HIV Drug Resistance -- Workshop, July 17-18.  The Conference 
Secretariat, International Clinical Forum Consultants, Wicker 
House, West Sussex, United Kingdom, 44-903-205-213, fax 44-903- 
210-296. 
 
STD Diagnostics Initiative -- Annual Meeting, July 16 and 17, 
Secretariat, STD Diagnostics Initiative, PATH, Seattle, 
Washington, 206/285-3500, fax 206/285-6619. 
 
Ethical Aspects of HIV/AIDS -- Workshop, July 27.  Rob 
Tielman/Jean Davies, International Humanist and Ethical Union 
(IHEU), Utrecht, 31-39-31-21-55, fax 31-30-36-71-04. 
 
Euthanasia, Medical, Ethical and Legal Issues -- Workshop, July 
29.  Rob Tielman/Jean Davies (see above) 
 
Endpoints in HIV Clinical Trials, July 18, 14:00-18:00.  Dr. J. 
A. M. Lange, National AIDS Therapy Evaluation Center (NATEC), 
Academic Medical Center, University of Amsterdam, 31-20-566-43- 
80/44-79, fax 31-20-691-88-21. 
 
Slide Seminar in Oral Pathology, July 24-25.  Mrs. D. Chevalking, 
Congress Secretariat Oral Pathology, Free University Hospital, 
Department of Oral Pathology, Amsterdam, 31-29-548-2306, fax 31- 
20-548-5226. 
 
Corporate Satellite Meetings 
 
HIV Treatment Strategies for the 1990s, July 19, 10:30, in Grote 
Zaal, RAI Center.  The Wellcome Foundation Limited, contact 
Caroline Gay, Kent, England, 081-658-2211, fax 081-650-9862. 
 
Gastrointestinal Disorders in HIV-Infected Patients, July 20, 
19:30 in Forum Zaal, RAI Center.  Sandoz Pharmaceuticals 
Corporation, contact Tammy Altmark, Audio Visual Marketing, Inc., 
New York, 212/614-1370, fax 212/979-1214. 
 
Management Strategies for Cytomegalovirus and Other Herpesvirus 
Infections, July 20, 19:30 in Grote Zaal, RAI Center.  Astra 
Pharmaceutical Products Inc., contact:  Deborah Rachlin, 
Triclinica Communications, Inc.  New York, 212/698-4084, fax 
212/698-4003. 
 
Polymerase Chain Reaction:  Diagnostic Kits for HIV, Mycobacteria 
and the Implications for Diagnosis of Opportunistic Infections, 
July 21, 19:30 in Midden Zaal, RAI Center.  Roche Molecular 
Systems, contact:  Thomas H. Callaway, M. D., Director of 
Scientific Affairs, Sommerville, New Hampshire, 919/361-7735, fax 
919/361-7797. 
 
Therapeutic Treatment of HIV Patients:  Clinical and Laboratory 
Tools, July 22, 19:30 in Grote Zaal, RAI Center.  Bristol-Myers 
Squibb Company, contact Leif Anderson, Health Science 
Communications, New York 212/727-1337, fax 212/727-2463. 
 
The Evolution of Community Care, July 21, 19:30 in Grote Zaal, 
RAI Center.  Caremark, contact:  Dr. Patrick Rafferty, Berkshire, 
United Kingdom, 44-635-200-020, fax 44-635-578-800. 
 
***** Anti-Drug Politics Impede Medical Use of Marijuana 
 
by Denny Smith 
 
     Two government bureaucracies have recently decided to uphold 
regressive positions on the therapeutic use of marijuana 
(Cannabis sativa), and the effect of the decisions was given an 
added sting by the death last week of Barbra Jenks, a Florida 
woman with AIDS who was once arrested for growing marijuana for 
her personal medical use. 
 
     On March 18, The U. S. Drug Enforcement Administration (DEA) 
decided to uphold its barricade against medical access to 
marijuana.  (For background information, see AIDS TREATMENT NEWS 
issues #131 and #139.)  The decision comes almost one year after 
a Court of Appeals ordered the DEA to reconsider that position, 
and one week after the U. S. Public Health Service revealed that 
it would not expand its compassionate-use marijuana program 
(beyond the twelve patients now receiving government-grown drug). 
An estimated 300 people had applications pending for 
compassionate access to marijuana. 
 
     The decisions have been widely and sharply criticized. 
While the oral drug Marinol (a pharmaceutical version of 
marijuana's component THC) is available by prescription, many 
people with severe nausea and vomiting prefer marijuana.  The 
Public Health Service argument that smoking marijuana could cause 
lung infections is generally regarded as specious, since the 
dried plant can easily be sterilized.  The American public 
appears to support medical access to marijuana:  35 states have 
acknowledged its therapeutic value, and last November the city of 
San Francisco voted four to one to add it to California's list of 
approved medicines. 
 
     Reaction to the decisions was particularly critical from 
four organizations which have been working to reverse the 
criminalization of medical marijuana:  the Alliance for Cannabis 
Therapeutics (ACT), the Marijuana AIDS Research Service (MARS), 
and the Drug Policy Foundation, all based in Washington, D. C., 
and the American Medical Marijuana Movement (AMMM), based in San 
Francisco. 
 
     Spokespersons for ACT and the Drug Policy Foundation told us 
that lawmakers are timidly deferring to the Bush administration's 
indiscriminate war on drugs, and that they need to hear from the 
public to chart a more rational course.  ACT is encouraging people 
who disagree with the government's position on medical marijuana 
to register their opinion with their senators and congressional 
representatives, and with the following legislative committees: 
 
     * Labor and Human Resources, Room SD-428, U. S. Senate, 
Washington, D. C., 20010, telephone 202/224-5375. 
 
     * Subcommittee on Health, 2415 RHOB, U. S. Congress, 
Washington, D. C., 20015, telephone 202/225-4952. 
 
     For more discussion of the role of marijuana in HIV therapy, 
we recommend the book "Marijuana & AIDS:  Pot, Politics & PWAs in 
America," written by Robert Randall, President of ACT, and 
published by Galen Press.  The book includes a chapter comparing 
marijuana and Marinol, as well as testimony given at a DEA 
hearing by Ivan Silverberg, M. D., a San Francisco oncologist who 
has treated many people with AIDS. 
 
     Barbra Jenks, who died on March 28, was in the eye of the 
national media when she and her husband Kenny went on trial for 
marijuana cultivation.  The Florida Supreme Court eventually 
cleared the couple of the charges by reason of medical necessity, 
and Kenny Jenks continues to survive with AIDS.  In 1990, in her 
affidavit for the trial, Ms. Jenks told the court: 
 
     "In every sense of the word, marijuana made a critical 
difference in my medical care.  We were not throwing up.  We were 
eating well and our weight was coming back.  Kenny, despite his 
low T-cell count, continued working and bringing home a paycheck. 
Our mood was good. 
 
     "Because we were eating well, we were able to continue 
taking AZT, the only drug known to help retard the HIV virus. 
Many patients, unable to tolerate the intense nausea and vomiting 
of AIDS and AZT therapy, are forced to quit AZT.  Unable to 
tolerate treatment, their disease becomes progressive and they 
rapidly fall prey to opportunistic infections.  Marijuana helped 
us avoid this dangerous trap. 
 
     "Things went on like this for a year.  Our health was stable,  
our spirits good.  We stayed out of the hospital and with each  
other.  Odd as this may seem, we were generally happy.  I thank  
God for each day I am alive and try to make the best of each day." 
 
Comment 
 
     The eloquence of Barbra Jenks, a 25-year old woman with 
AIDS, won a victory in Florida for all people who may one day 
need to use marijuana.  She spent her limited time and energy 
fighting what many consider a foolish and heartless national 
policy.  Meanwhile, the federal government remains intransigent 
on the issue.  Dennis Peron of AMMM told us that California alone 
spends $17 million annually trying (unsuccessfully) to eradicate 
marijuana cultivation, and that the U. S. government's total 
expenditures for its controversial drug war is $17 billion a 
year.  Such a sum invites us to question why funding for medical 
research and health care is always a struggle at budget time. 
Perhaps these grossly tilted priorities will yet become an 
election-year issue. 
 
***** Announcements 
 
** Alternative Treatments:  San Francisco Forum, April 18 
 
     A free public  forum, "Alternative Approaches to the 
Treatment of HIV," will be held April 18th from 1:00 to 4:00 p.m. 
at Davies Medical Center Auditorium, Castro and Duboce Streets, 
in San Francisco.  Panelists will include persons with HIV, and 
practitioners of acupuncture, Chinese herbal medicine, Ayurvedic 
medicine, and massage therapy.  This event is sponsored by ACT 
UP/San Francisco, AIDS Treament News, PHREDA Project, the San 
Francisco AIDS Foundation, and Women's AIDS Network.  For more 
information, call 415/255-0824. 
 
** Meet Your Local Congresspersons Help Fund AIDS Research and 
Care 
 
     Mobilization Against AIDS has called a national AIDS lobby 
day on May 18Qthe day after the international AIDS candlelight 
memorial, which occurs in over 100 U. S. cities.  Most members of 
Congress have never met a person with AIDS or HIV from their home 
district; that is why they do not sense the seriousness of the 
epidemic.  On May 18, people with AIDS or HIV or their supporters 
anywhere in the U. S. will meet their Congresspersons or 
assistants in their local district offices (you do not need to 
travel to Washington) to ask for adequate funding for AIDS 
research, education, and treatment. 
 
     Mobilization Against AIDS will provide information and help 
you prepare for this meeting.  For more information, call them 
toll-free at 800/24-LOBBY. 
 
** Help Wanted:  AIDS TREATMENT NEWS Needs Marketing/Outreach 
Coordinator 
 
     AIDS TREATMENT NEWS needs someone with marketing experience 
and achievement, who is familiar with HIV treatments and 
organizations, to work half to full time to market the newsletter 
and to develop other forms in which our information can be used. 
We cannot pay market rates for the expertise we need, so we are 
looking for someone who believes in what we are doing and would 
like to work with us.  We do offer full health coverage (Kaiser). 
 
     When we began, AIDS TREATMENT NEWS did no advertising, 
marketing, or community outreach, but relied only on word of 
mouth.  More recently we have used conference exhibits, direct 
mail, and display advertising.  We want to continue these efforts 
when appropriate; but we expect to focus on building 
relationships with community and service organizations, 
corporations, the media, and others, through special projects 
which are useful to them. 
 
     If you are interested, send a resume before May 1 to:  AIDS 
TREATMENT NEWS, P. O. Box 411256, San Francisco, CA 94141. 
 
***** 
 
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: 
   John S. James 
   Michelle Roland 
   Denny Smith 
Reader Services, Business, and Marketing: 
   Thom Fontaine 
   Jason Heyman 
   Laura Thomas 
   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 
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   Special discount for persons with financial difficulties: 
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   Back issues available. 
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   Please send U. S. funds:  personal check or bank draft, 
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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