
AIDS TREATMENT NEWS Issue #246, May 3, 1996
   phone 800/TREAT-1-2. or 415/255-0588

CONTENTS:

Saquinavir: Combination Shows Survival Benefit; New Formulation 
Trial Recruiting

Improved HIV Survival Indicates Effect of Therapy

Kaposi's Sarcoma: DaunoXome(R) Approved

Crixivan(R) Price: Behind the Reduction

California: 3TC Now Available through ADAP

Women and HIV: Conference Calls May 14 and May 15, on Treatment 
Concerns

Alternative Treatments for HIV: Nationwide Survey Seeks Users

Federal Policy: Ryan White, OAR, Testing Newborns

AIDSWatch 1996: National Lobbying Days in Washington,
May 19-21

Paris Conference on NAC, Similar Therapeutic Approaches,
May 21-23

Vancouver Conference Satellite Meetings, Part II


***** Saquinavir: Combination Shows Survival Benefit;
New Formulation Trial Recruiting

While three protease inhibitors are now approved for treatment of 
HIV infection, until now only one (Abbott's ritonavir, brand-name 
Norvir(TM)) had demonstrated in a clinical trial that it can reduce 
disease progression and increase survival of patients. On May 7, as 
this newsletter went to press, Hoffmann-La Roche released survival 
analysis of a major clinical trial comparing its protease inhibitor 
saquinavir (INVIRASE(TM)) plus ddC (Hivid(R)) vs. saquinavir alone 
vs. ddC alone. The combination showed a substantial survival 
benefit, with 28 deaths on ddC alone and 34 on saquinavir alone, but 
only 9 on the combination treatment -- a two-thirds reduction in 
deaths.

The two groups were also compared on disease progression -- 
defined as the number of persons who either died or had their first 
AIDS-defining event. There were 85 such progressions on ddC, 77 on 
saquinavir, and 46 on the combination. An analysis of time to event 
(not just number of events) showed a reduction of disease 
progression risk of slightly over one half with the combination, 
compared to ddC alone.

In both cases, the improvement of the combination vs. ddC alone was 
highly statistically significant, in this intent-to-treat analysis.

The trial volunteers had baseline CD4 counts between 50 and 300, 
and had at least 16 weeks of prior treatment with AZT. The 
treatment arms were balanced with respect to sex, age, race, 
baseline viral load, baseline CD4 count, and reason for discontinuing 
AZT; however, there had been less prior AZT therapy (68 weeks) in 
the combination group than in the other groups (74-75 weeks).

Discontinuation for toxicity was highest in the ddC arm. The 
combination did not seem to increase ddC toxicity.

Comment

It is encouraging that a second protease inhibitor has now proven 
that it can increase survival (when used in combination). The data 
above indicate that saquinavir did not work well alone. Probably this 
is because the approved dose is too low; but even with a better dose, 
or with any other protease inhibitor, use in combination with other 
antiretrovirals will probably be strongly preferred.

The reason ddC was chosen for use in this saquinavir trial is that 
the two drugs are marketed by the same company -- and also 
because this trial began recruiting in February 1994, when ddC was 
a reasonable choice. ddC need not be chosen today for combination 
use with saquinavir.

Our impression is that saquinavir (in its new formulation, which 
delivers a higher blood level -- or possibly in combination with 
ritonavir, if it is found possible to combine these drugs safely) will 
work much better than the currently approved dose and formulation, 
and become an important drug; but the research is not yet available 
on how to use it optimally. ddC, however, will be much less 
important in the future, because of its relatively small benefit vs. 
relatively high toxicity, although it can still be useful for some 
patients in some combinations.

New Saquinavir Trial

A trial of the new formulation of saquinavir (the soft gelatin 
capsule, which is more bioavailable than the currently approved 
drug) is now enrolling in 40 sites across the U.S. Although 400 
volunteers were needed, about half enrolled in the first 10 days.

Volunteers must be at least 13 years old, and at least three quarters 
of those enrolled must not have used any protease inhibitor before. 
Any CD4 count may be allowed, but only 100 of the 400 volunteers 
can have counts of 100 or less.

All volunteers will receive the same dose of the new formulation of 
saquinavir for at least one year. Volunteers are allowed to use other 
antivirals during this trial, but not other protease inhibitors until 
safety information is available.

For more information, or to contact a site near you, call the AIDS 
Clinical Trials Information Service, 800/TRIALS-A.


***** Improved HIV Survival Indicates Effect of Therapy

by John S. James

On May 1, Johns Hopkins researchers published an epidemiological 
study of survival of persons who were HIV-positive but did not have 
any AIDS-defining conditions.(1) They found a significant increase in 
survival between the years before and the years after widespread 
availability of pneumocystis prophylaxis and antiviral monotherapy. 
Because this study compared the time periods of 1985-1988 with 
1989-1993, it could only record effects of therapies in wide use in 
the years between 1989 and 1993 -- ignoring effects of more 
modern strategies like protease inhibitors, widespread combination 
antiretrovirals, and viral load tests. (Recent data could not be 
compared, since several years must elapse to provide accurate 
estimates of length of survival.)

For those without an AIDS-defining condition and without symptoms 
of AIDS but with a CD4 (T-helper) count between zero and 100, 2.5-
year survival increased from 22% to 54% between the period 1985-
1988 to 1989-1993. For those with a CD4 count of 101-200, 
survival increased from 53% to 71% between those two periods. For 
those with CD4 in the range of 201-350, the same 2.5-year survival 
increased from 83% to 91%.

For those with a CD4 count of over 350, the overall three-year 
survival rate was 94% or greater, and there were too few deaths to 
see if there was a difference from the earlier to the later period. 
However, those with CD4 counts over 350 who reported having 
certain AIDS-related symptoms (less than required for an AIDS 
diagnosis) had a 1.6 to 2.3 times higher relative hazard of dying than 
those who had had no such symptoms. (The presence of symptoms had 
a greater effect on relative hazard at higher CD4 counts than at 
lower counts, "indicating that the presence of clinical symptoms in 
the absence of AIDS was a stronger predictor among those with less 
compromised immune systems.")

This study could not compare the changing risk between the calendar 
periods for those who started with an AIDS diagnosis, because the 
data used came from the MACS study (Multicenter AIDS Cohort 
Study), which enrolled 4,954 gay men in four U.S. cities (both HIV-
positive and HIV-negative) in 1984-1985. The MACS entry criteria 
excluded those who already had AIDS; therefore, the small number 
who had developed AIDS by the period of 1985-1988 would not have 
been representative. This study did find that the presence of AIDS 
(by the old definition, which required at least one opportunistic 
infection or condition) increased the risk of death by about two to 
six times, compared to those with the same CD4 count but without 
AIDS and without other symptoms; however, the data available did 
not allow accurate estimation of this increase in risk.

This study has limitations. For example, the researchers indicated 
that there were differences between the earlier and later cohorts 
which may not have been completely adjusted for by the statistical 
methods used; therefore, certain biases may have accounted for 
some of the survival differences. Also, while the two calendar-year 
cohorts were selected to show a before-therapy to after-therapy 
change, not everybody in the later group used treatment, and some in 
the earlier group did, suggesting the possibility that the improved 
survival due to the treatments available in 1989-1993 could have 
been greater than this study indicated.

Comment

While the two cohorts in this study were selected to show 
differences due to pneumocystis prophylaxis and early antiviral 
therapy, there have also been many other improvements in medical 
management, especially as physicians have learned more about how 
to diagnose and treat patients with opportunistic infections. This 
improved medical management is harder to attribute to particular 
calendar years, but it would also have contributed to the survival 
improvement found in this study.

This study suggests that persons without AIDS and with high CD4 
counts should also look at AIDS-related symptoms as a factor in 
planning therapy; these indicated a worse prognosis, and therefore 
would seem to argue for a somewhat more aggressive approach to 
therapy than for asymptomatics. The symptoms recorded in this 
study were "an unintentional weight loss of at least 4.5 kg since the 
previous visit [visits were every six months], presence of fatigue 
for at least two weeks, oral thrush or candidiasis for at least two 
weeks, persistent fever higher than 37.9 degrees C for at least two 
weeks, and diarrhea for at least two weeks."

References

1. Enger C, Graham N, Peng Y, and others. Survival from Early, 
Intermediate, and Late Stages of HIV Infection. JAMA. May 1, 1996; 
volume 275, number 17, pages 1329-1334.


***** Kaposi's Sarcoma: DaunoXome(R) Approved

DaunoXome, a liposomal form of the cancer chemotherapy drug 
daunorubicin, was approved by the FDA on April 8, and became 
available from distributors in the first week of May. It is approved 
as first-line chemotherapy for patients with advanced HIV-related 
KS -- and NOT recommended for less than advanced KS. Its main 
advantage is reduction in certain side effects compared with 
conventional chemotherapy.

Liposomal drugs are formulations in which the active chemical is 
enclosed in microscopic globules of fat. This can improve the 
targeting of certain drugs, causing more to be delivered to the tumor 
where it is needed, and less to go elsewhere in the body where it can 
cause side effects. Liposomal drugs tend to target both KS lesions 
and cancer tumors; the reason why is not known, but it is suspected 
that the liposomes leak out of defective blood vessels which grow in 
the lesions or tumors. (DaunoXome is also being tested for various 
cancers; at this time it is approved only for KS, although physicians 
can use it "off label" for other purposes.)

DaunoXome, which is being marketed by NeXstar Pharmaceuticals of 
San Dimas, California, is the second liposomal chemotherapy drug 
approved; the first, DOXIL(R), which is liposomal doxorubicin (it is 
named DOX-SL outside the U.S.), was approved in late 1995 (see AIDS 
TREATMENT NEWS #236). The two drugs have not been tested head-
to-head in a trial, and are not likely to be, so there are no data 
comparing them. One major difference is that DaunoXome has been 
approved for first-line use, while DOXIL has been approved for KS 
patients who have failed standard chemotherapy.

Also, DaunoXome is been priced less than DOXIL; according to 
NeXstar, its price is comparable to that of standard chemotherapy. 
This cost advantage is partly offset by the fact that DOXIL is infused 
once every three weeks, while DaunoXome is infused once every two 
weeks, increasing the total infusion cost. NeXstar has a patient-
assistance program to help in paying for the treatment; for more 
information (or to enroll), patients, physicians, or social workers 
can call 800/226-2056.

The major acute toxicity of DaunoXome is bone-marrow suppression 
-- especially loss of granulocytes (including neutropenia, which can 
lead to serious or life-threatening infections); blood tests are 
necessary so that treatment can be interrupted if required.

With the conventional form of daunorubicin, the most serious long-
term risk is cumulative heart toxicity. This appears to be much less 
of a problem with the liposomal form of the drug. But because it is 
possible, the DaunoXome package insert begins with a prominent 
warning to monitor for possible heart toxicity -- especially for 
patients who are at risk, due to previous heart problems or previous 
use of this class of drug. 

Many but not all side effects are less with DaunoXome than with the 
conventional chemotherapy most likely to be used instead (ABV, 
which is a combination of Adriamycin (doxorubicin), bleomycin, and 
vincristine). For example, neuropathy was reduced from 38% to 12%, 
and hair loss from 36% to 8%, in the major phase III trial which 
compared DaunoXome to ABV in a total of 227 patients.

Since chemotherapy is not a cure for KS, treatment may need to be 
continued indefinitely, or for as long as the drug continues to work.


***** Crixivan(R) Price: Behind the Reduction

by John S. James

Our last issue (AIDS TREATMENT NEWS #245) noted that patients 
who are paying out of pocket for the Merck protease inhibitor 
indinavir (Crixivan), which they can only purchase from Stadtlanders 
Pharmacy, can save $97 per month just by obtaining a discount card 
from a competing mail-order pharmacy, Community Prescription 
Service (phone 800/842-0502). The cost of the discount card is $18. 
Because this price reduction was announced just before our previous 
issue went to press, we did not have time to explain how it occurred.

For big organizations like insurance companies, HMOs, and 
government agencies, pharmaceutical prices are like hotel-room 
prices; almost nobody pays the officially stated price. Instead, each 
company negotiates a lower price which it pays for the clients it 
covers. But in pharmaceuticals, unlike hotels, individuals are usually 
excluded from these price reductions. Therefore, persons who have 
to buy their drugs out of pocket pay the highest price; organizations 
pay substantially less. (Some individual pharmacies have sold some 
drugs at or near cost, as a community service; this does not affect 
the wholesale price, however.)

In the case of Crixivan, an unusually high markup, plus charging 
individuals paying out of pocket the highest price while insurance 
companies and HMOs paid less, led to widespread protest against 
Stadtlanders. Merck had established an unexpectedly LOW price 
which it charged wholesalers for this drug, $12 per day. But 
Stadtlanders, a company well known for service and for supporting 
the AIDS community, temporarily became both the only wholesaler 
and the only retailer that individuals could use to buy Crixivan. It 
charged out-of-pocket customers $16.50 per day -- a wholesale and 
retail markup together of 37.5%, or over $1600 per year for filling 
12 prescription bottles. The high markup plus the highest price for 
cash customers led to the protests.

In practice, almost all Crixivan sales were at lower prices through 
insurance plans, as few individuals can pay for their own protease 
inhibitors. Therefore, the extra profit from the high price to 
individuals would not make much financial difference to 
Stadtlanders. But according to Stadtlanders, for legal reasons a 
pharmacy cannot establish multiple levels of retail pricing (such as 
a cash discount to individuals). [Comment: If this is true, then 
Congress needs to be told that its laws are creating an injustice, by 
allowing discount pricing to every insurance company and HMO, while 
forbidding similar discounts to unorganized individuals, who have to 
pay more than any organization when buying drugs out of pocket.]

Stadtlanders found a way out of this situation by agreeing to 
recognize the discount card of CPS, which was already honored by 
about 60% of pharmacies in the U.S. This way individuals could get 
contract prices like those negotiated with insurance companies, 
HMOs, and government agencies. The official price (for individuals 
who do not get the card) is still $16.50 -- but no one needs to pay 
that price any more, and fewer people will pay it. With the card, the 
cash price is reduced to $13.27, saving patients $97 per month. 
(Stadtlanders will not accept the CPS card in conjunction with any 
other drug card or insurance coverage, meaning that individuals with 
other coverage must pay cash up front if they use the CPS card, and 
be reimbursed later.)

This reduction would never have happened except for the protests, 
which were led primarily by several organizations: ACT UP/Golden 
Gate, ACT UP/New York, ACT UP/Philadelphia, the PWA Coalition of 
New York, and the PWA Health Group (the largest buyers' club in New 
York). The protests included substantial publicity, as well as several 
persons arrested for posting signs on Stadtlanders' New York City 
outlet. Apparently the fear of a public-relations reversal pressured 
Stadtlanders into finding a solution, when the hardship to 
individuals who had to pay the unrealistic official price did not do 
so. It is widely believed that some other AIDS organizations may not 
have supported the protest because they had been funded by 
Stadtlanders, but there is no way to know for sure.

In the long run, what is happening is that individuals are 
increasingly being pressured to organize into groups, to avoid being 
at a serious disadvantage because they do not have the negotiating 
clout that large organizations do. The Stadtlanders events have 
spurred activists to look into other AIDS-drug pricing issues, and 
already they are finding remarkably large variations from pharmacy 
to pharmacy in what individuals have to pay. Often it is quite 
unexpected who is charging much more, and who much less, for the 
same drug. Price is not everything, as some companies give better 
service (which can make the difference between whether or not 
someone gets a prescription they need), and some pharmacies 
support community organizations while others do not. But if those 
patients who must be concerned about price are not advised how big 
the variations are, and where to find the lowest prices, we have a 
problem. Activists are now likely to work harder on immediate price 
issues, publicizing large variations and getting comparison 
information to patients who need it.

The Crixivan price reduction was a remarkable victory which shows 
how beneficial activism can be. But there is still concern that the 
high nominal price could set a precedent for higher distribution 
costs in the future.


***** California: 3TC Now Available through ADAP

On April 25, lamivudine (3TC) was added to the list of drugs 
available from California's AIDS Drug Assistance Program. According 
to the California Department of Health Services, this was made 
possible by an additional $2.3 million in funds, over $2 million of 
which was from voluntary rebates on drugs purchased from Glaxo 
Wellcome Inc., which markets AZT as well as 3TC. The ADAP program 
in California has been under financial strain, because the number of 
prescriptions filled increased from 96,000 in the last fiscal year to 
almost 150,000 this year. Most other states' ADAP programs have 
similar financial difficulties.

It is considered likely, although not certain, that California's ADAP 
will be able to pay for 3TC, as well as one or more protease 
inhibitors, in fiscal year 1996-1997.


***** Women and HIV: Conference Calls May 14, 15, on Treatment 
Concerns

BETA (BULLETIN OF EXPERIMENTAL TREATMENT FOR AIDS), the 
quarterly AIDS treatment magazine published by the San Francisco 
AIDS Foundation, is sponsoring free nationwide interactive 
telephone conference calls on the special treatment concerns of 
women with HIV/AIDS. The first call will be on Tuesday May 14, and 
there will be another on May 15; both calls begin at 3:30 p.m. Pacific 
time (6:30 Eastern time). Callers can listen to and ask questions of a 
panel of experts. These phone conferences are supported by an 
educational grant from Hoffmann-La Roche.

To join one of these calls, you need to register in advance, by calling 
800/707-BETA.

***** Alternative Treatments for HIV: Nationwide Survey 
Seeks Users

A well-designed study of complementary and alternative medicine is 
now recruiting 1500 persons who are using alternative medicine in 
HIV/AIDS treatment -- regardless of whether or not they are also 
using conventional medicines in addition. If you are HIV-positive, at 
least 18, able and willing to give informed consent and 
independently complete study forms, and a U.S. resident, you are 
eligible for this study.

Participants will fill out a 25-page questionnaire every six months 
for at least a year. A small compensation ($10 or $15) will be 
provided for each completed questionnaire.

About the Study

This survey is using a well-known technique called "outcomes 
research," to see if the use of certain treatments is associated with 
better or worse medical outcomes than others. Outcomes research 
uses repeated health status evaluations in ordinary care settings. 
This methodology has both advantages and disadvantages vs. 
randomized controlled trials. Unlike randomized controlled trials, 
outcomes research does not find a causal relationship, so it cannot 
provide definitive proof that a treatment is beneficial. But it can 
identify an association of good or bad results with a particular 
therapy, producing prospective, systematically collected 
information which can be helpful for designing trials, as well as for 
making treatment decisions.

Outcomes research examines medical care as it is actually 
delivered, avoiding both the ethical concern about randomizing 
patients to predetermined protocols, and also the difficulty in 
generalizing from highly selected cohorts and artificial protocols to 
patients in general practice. But on the other hand, outcomes 
research does not have the internal validity of randomized 
controlled trials, and often needs larger numbers of patients to 
obtain statistically significant results.

This alternative-treatment survey is being conducted by Bastyr 
University, an accredited multidisciplinary natural medicine 
university, with funding from the National Institutes of Health 
Office of Alternative Medicine. The principle investigator is Leanna 
Standish, N.D., Ph.D., of the Bastyr University AIDS Research Center. 
The trial was designed primarily by Carlo Calabrese, N.D., M.P.H., who 
is widely recognized as an expert in outcomes research in 
alternative medicine. It is the only large-scale study of alternative 
medicine for the treatment of HIV/AIDS now taking place in the U.S.

For more information, or to volunteer, call 800/475-0135. 
Physicians and other practitioners who are interested in working 
with this study can call Project Coordinator Cherie Reeves, 
206/517-3578. More information is also available on the World Wide 
Web, http://www.bastyr.edu/research/recruit.html.


***** Federal Policy: Ryan White, OAR, Testing Newborns

by John S. James

With the recent budget compromise between the White House and 
Congress (the omnibus budget agreement, which is for fiscal year 
1996, which ends in five months), AIDS advocacy groups won four of 
the five issues on the table in this budget negotiations:

* Increased funding for the Ryan White CARE Act. The AIDS Drug 
Assistance Program (which helps individuals with limited incomes 
pay for certain prescription drugs) received an increase of $52 
million, as had been expected. In addition, there was an unexpected 
increase of $30 million for the Ryan White program overall, due to 
the work of AIDS advocates and of the White House.

* Repeal of the HIV military discharge. The budget compromise 
repeals the law introduced by Congressman Robert Dornan 
(Republican, California) which would have required the military to 
discharge over a thousand service men and women with HIV.

* Saving the AIDS Education and Training Centers. This program will 
be cut, but not eliminated, as had been feared.

* Saving Housing Opportunities for People with AIDS (HOPWA). This 
program is flat funded (neither increased nor decreased) for fiscal 
1996 -- which is better than had been expected.

Negotiations for fiscal 1997 (which begins October 1, 1996) are 
already well underway. It is important that the concerned public 
understands the outline of the major AIDS issues involved, so that 
we can provide grassroots support for our lobbying organizations 
when necessary.

The OAR Budget Issue

The issue which AIDS groups lost in the budget negotiation was the 
consolidated budget authority for the OAR (Office of AIDS Research) 
-- authority which the OAR has had for more than two years. Almost 
all AIDS organizations involved in this issue strongly support letting 
the OAR keep this authority, and will be pushing hard to restore it 
for fiscal 1997.

A central argument for OAR budget authority is that while other 
major diseases have their own Institutes at the National Institutes 
of Health (e.g., the National Cancer Institute), a separate AIDS 
Institute is not possible right now, and might not be best anyway, 
because AIDS is related to so many branches of medicine that AIDS 
research can best take place within the other Institutes, as it 
already does. Instead, the OAR with budget authority constitutes an 
"Institute without walls," allowing AIDS research to be coordinated 
and made more efficient. Without budget authority, each separate 
Institute will be its own fiefdom, leading to the kinds of 
inefficiencies and lost opportunities which occurred during the first 
decade of AIDS research.

One AIDS treatment organization involved in the issue, Project 
Inform, has raised other concerns. It sees the issue of OAR budgetary 
authority as largely symbolic, since either way the NIH director will 
ultimately make the key decisions, using plans worked out by the 
OAR and the Institutes. In neither case can the OAR or the Institutes 
act independently; in both cases, compromise and consensus, not 
OAR's budget authority, will determine what happens. But Martin 
Delaney of Project Inform fears that one cost of OAR budget 
authority is that every year's AIDS research funding will have to be 
debated with the whole Congress, not just within NIH. Project 
Inform is not opposing the OAR consolidated budget, but wants more 
examination of the entire issue -- including the possibility of an 
AIDS Institute.

Mandatory Testing of Newborns -- Comment

On a separate issue (not decided as part of the omnibus budget 
negotiations), Congress is likely to require that states with over 
10% of the nation's pediatric AIDS cases begin mandatory HIV 
testing of newborns in two years, unless each state can first meet 
certain standards through voluntary testing programs. Since the 
standards proposed appear unrealistic, this legislation will probably 
require states to begin mandatory testing of newborns -- or 
sacrifice Ryan White Title II AIDS funding, the penalty for not doing 
such testing. (Antibody testing of newborns reveals the mother's HIV 
infection, not the baby's -- and is too late to help prevent 
transmission of HIV to  the baby.)

Language in the legislation requires counseling for pregnant women 
and voluntary HIV testing, measures long advocated by AIDS and 
public health groups as the best approach for reducing perinatal 
infection. But in the same provision, Congress undermines this 
approach by mandating newborn testing when it is too late to 
prevent infection.

The most effective way to prevent mother-to-infant transmission 
would include appropriate prenatal care so that women can use the 
test results effectively. Most pregnant women with HIV are poor and 
unlikely to be insured. They may not be able to get the care they need 
to reduce the chance of transmitting HIV to their children. They may 
be subject to violence if they test positive and that becomes known. 
Testing is necessary, but it should be part of a comprehensive 
program in cooperation with the mother, not imposed on her by 
Congress regardless of her concerns and her situation.

The real issue is money. It costs money to provide medical care for 
poor women before, during, and after birth. But it costs nothing for 
Congress to feel like it is doing something about pediatric AIDS by 
requiring mandatory testing. This empty gesture will be at the 
expense of states, which will probably have to cut other AIDS or 
health programs to comply.


***** AIDSWatch 1996: National Lobbying Days in Washington, May 
19-21

A number of organizations are sponsoring this year's AIDSWatch, in 
which people from across the country travel to Washington D.C. to 
meet with their Congressional representatives or their staffs. 
Participants can get help in arranging appointments, and can attend 
two daily briefings on current AIDS issues and on how to advocate 
effectively. Last year over 500 people from 40 states participated.

On Sunday, May 19, training, briefing, and registration will be from 
2:00 p.m. to 6:00 p.m. at the National Education Association 
auditorium, 1201 16th St. NW (but check with the organizations 
involved, in case there are any late changes). After the briefing, the 
International Candlelight Memorial Washington vigil will be held at 
Lafayette Park, across the street from the White House, from 6:30 
p.m. to approximately 7:00. After the vigil, the official AIDSWatch 
reception will be at Cafe Sesto, at 15th and K St. NW.

Monday the 20th and Tuesday the 21st are the AIDSWatch 
Congressional appointment days. Also, there will be briefings at 
8:00 a.m. and 4:00 p.m. at the Methodist Building, 110 Maryland 
Avenue NE, near the Capitol.

For more information, including suggestions on travel and hotel 
arrangements, contact Lisa Ragain, National Association of People 
with AIDS, 202/898-0414.


***** Paris Conference on NAC, Similar Therapeutic Approaches, 
May 21-23

A conference on "Oxidative Stress and Redox Regulation: Cellular 
Signaling, AIDS, Cancer, and other Diseases" will be held May 21-24, 
1996, at Institut Pasteur in Paris. Co-chairs are Luc Montagnier, 
Catherine Pasquier, and Thomas Tursz; the scientific organizer is 
Rene Olivier. Speakers include: Lenore A. Herzenberg, "Outcomes of 
NAC Clinical Trial in HIV-Infected People: Rise in Whole Blood 
Glutathione and Increased Survival Time";  Leonard A. Herzenberg, 
"Glutathione and Oxidative Stress: Measures in HIV/AIDS"; and Dr. 
Wulf Droge, "Role of Cysteine and Glutathione in the Pathogenesis of 
HIV Infection -- Effects of Treatment with N-Acetyl-Cysteine." 
There are also several talks on apoptosis (programmed cell death) in 
lymphocytes in AIDS, and more on other scientific topics; we 
mentioned the NAC papers because they are more likely to be 
familiar to our readers. The scientific presentations will be in 
English. 

Detailed information is available on the World Wide Web, 
http://notes.immunet.org/redox/index.html; conference abstracts 
will later be available on the Web. Registration is through Europa 
Organization, fax (33) 61 21 28 54 or (33) 61 21 28 57.


***** Vancouver Conference Satellite Meetings, Part II

Our last issue published an overview of the scientific program of the 
XI International Conference on AIDS (Vancouver, July 7-12, 1996), 
with notes on travel arrangements, skills building meetings, 
Community Forum 96, and the satellite meetings scheduled for July 
5 and 6, before the official conference begins. We did not have space 
for the satellite meetings July 7 to July 12, so they are listed here. 
We do not know of any conference-related meetings scheduled in 
Vancouver after July 12.

Resistance meeting note: A small invitational workshop on HIV 
resistance to antivirals occurs every year, often shortly before the 
international conference (which now takes place only in even-
numbered years). This year the Fifth International Workshop on HIV 
Drug Resistance will meet in Whistler, Canada, July 3-6. A written 
summary should be available at the Vancouver conference.

Satellite Meetings

July 5 and 6

See AIDS TREATMENT NEWS #245.

Sunday July 7

 * Asia Pacific Alliance Against AIDS. Private & Public Partnerships 
for HIV Prevention in Asia Pacific.

 * Indigenous Peoples' Working Group. Indigenous Peoples' Gathering 
(continues Wednesday July 10).

 * International Women's AIDS Caucus. International Women's AIDS 
Caucus Meeting.

 * Canadian Foundation For Drug Policy & International Harm 
Reduction Association. Harm Reduction Around the World.

 * EUROCASO. Networking with Grassroots Organizations through 
Europe.

 * World Health Organization / UNAIDS. STD/HIV Interactions.

 * European Commission. The Europe Against AIDS Program of the 
European Commission.

 * Merck Sharp & Dohme. Protease Inhibitors: Treatment Strategies.

 * Hoffmann-La Roche Ltd. Changing Care: Evidence-Based Decisions 
in HIV and CMV Therapy.

 * Glaxo Wellcome and BioChem Pharma. Turning the Tide Against 
HIV: Recent Advances in Combination Antiretroviral Therapy.

Monday July 8

 * Gay Men's Health Crisis. Oral Sex Between Men: Research Update 
and Community Perspective.

 * Vancouver Hospital, Department of Dentistry. Oral Examination 
Practice Sessions and Identification of Oral Lesions of HIV for 
Health Care Providers.

 * European AIDS Treatment Group, Berlin, and Positive Women's 
Network. Women in Treatment Activism 1996.

 * National AETC Program, U.S. Department of Health and Human 
Services, Health Canada. Trinational Satellite Symposium: Innovative 
Partnerships in Education and Care between Health Professionals and 
People Living with HIV (continues July 9.)

 * Sexually Transmitted Diseases Branch, National Institute of 
Allergy and Infections Diseases, National Institutes of Health. 
Topical Microbicides.

 * Agouron Pharmaceuticals. Recent Advances in Combination 
Antiretroviral Therapy.

 * Gilead Sciences. Management of CMV Retinitis: Where Are We 
Today?

 * Ortho Biotech. HIV Infection and AIDS: New Biology, Therapeutic 
Advances, Clinical Implications.

 * NeXstar. Update on AIDS Related Liposomal Therapy in the Clinic.

 * Bristol-Myers Squibb Company. Improving Survival in People 
Living with HIV Infection: Current Therapies, Future Strategies.

Tuesday July 9

 * Hong Kong AIDS Foundation. Global Responses to HIV/AIDS from 
Chinese Communities.

 * International AIDS Society Lesbian, Gay and Bisexual Caucus. 
Caucus Meeting: Multiple Risks -- Multiple Threats.

 * International Christian AIDS Network. Celebrating Stories.

 * Panos Institute. On the Margins -- Donor Strategies.

 * Tzu Chi Institute. Complementary Medical Approaches for HIV 
Infection.

 * Vancouver Hospital, Department of Dentistry. Dental Care of HIV 
Positive Persons.

 * Living Well Project. AIDS: Combating Misinformation.

 * National Planning Forum for HIV/AIDS Research. Towards an 
HIV/AIDS Research Strategy for Canada: A Participatory Workshop.

 * Serono Laboratories Inc. State of the Art Approach to AIDS 
Wasting.

 * Direct Access Diagnostics. HIV and Telemedicine: Increased 
Access to High Quality Testing and Counseling Services through 
Technology.

 * Pfizer. The Immunocompromised State and Opportunistic 
Infections.

 * Boehringer Ingelheim and Roxane Laboratories. Non-Nucleoside 
Reverse Transcriptase Inhibitors: The New Class of Antiretrovirals.

Wednesday July 10

 * Canadian Hemophilia Society. Hemophilia, Blood Transfusion and 
HIV/AIDS.

 * Deutsche AIDS Hilfe. Developing New Paradigms for Safer Sex and 
HIV Prevention.

 * Panos Institute. On the Margins: Community Action.

 * Vancouver Hospital, Department of Dentistry. Clinical Pathologic 
Conference: Oral Lesions of HIV.

 * International AIDS Society -- USA. Guidelines for Antiretroviral 
Therapy: Bringing the State of the Art to Clinical Practice.

 * Sexually Transmitted Diseases Branch, National Institute of 
Allergy and Infectious Diseases, National Institutes of Health. 
Treatment of Sexually Transmitted Diseases to Prevent HIV 
Infection.

 * Serono Symposia USA Inc. Body Composition for the 3rd 
Millennium: Advances Since Archimedes.

 * Glaxo Wellcome. Co-Conspirators: Opportunistic Infections in HIV.

 * Abbott Laboratories. Emergence of a New Approach in HIV Disease 
Management.

 * Bio-Technology General Corp. The Weight Loss Dilemma: The Role 
of Anabolic Steroids.

Thursday July 11

No satellite meetings are scheduled, as of this time.

Friday July 12

 * AIDS, Medicine and Miracles symposium (for information, call 
303/447-8777).

 * National Pediatric & Family HIV Resource Center / Association 
Francois-Xavier Bagnoud International Pediatric HIV Training 
Program. Beyond Borders: Caring for the HIV-Infected Child.

 * British Columbia Coalition of People with Disabilities. Strategies 
in HIV/AIDS Prevention: Education for People with Disabilities.

 * Interagency Coalition on AIDS and Development. Influencing an 
AIDS-Affected Children and Youth Policy and Program Agenda.

 * International Christian AIDS Network. A Response to Vancouver: 
Were Faith Based Issues and Responses Acknowledged? Where to 
Next?

 * International Women's AIDS Caucus. International Women's AIDS 
Caucus Meeting.

 * St. Paul's Hospital. Ophthalmic Complications of AIDS in 
Developed and Developing Nations.

Contact Information

Conference Secretariat, XI International Conference on AIDS, 11th 
floor, 1090 West Pender, Vancouver, British Columbia, Canada V6E 
2N7; phone 800/780-AIDS, or 604/668-3225; fax 604/668-3242; 
email aids96@hivnet.ubc.ca; World Wide Web 
http://www.interchg.ubc.ca/aids11/AIDS96.html. (Note: the '11' in 
'aids11' is the number 11, as this is the 11th International 
Conference on AIDS; in 'html' the 'l' is the letter 'L'.)

***** AIDS TREATMENT NEWS
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AIDS TREATMENT NEWS reports on experimental and 
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and found combinations which work for them. AIDS 
Treatment News does not recommend particular 
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ISSN # 1052-4207 

Copyright 1996 by John S. James.  Permission granted for 
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