       Treatment Review #21 - March 1996

       Contents

       New Treatments Approved: New AIDS and HIV treatments, and
       combinations of existing treatments have recently been
       approved. One treatment has been shown to greatly reduce the
       amount of HIV virus in the body, and to help people stay
       healthy and live longer. This issue of Treatment Review
       provides basic information about existing HIV treatments and
       the new drugs that are available. We've also included fact
       sheets about all three approved protease inhibitors, and the
       newly approved combination treatment of 3TC and AZT.

       Combination Therapy: Good, unexpected news about an entirely
       new class of drugs called protease inhibitors. A new protease
       inhibitor has been clearly shown to help prevent disease
       progression and death in people with low T4 cells. A new
       combination treatment reduces the amount of HIV virus in the
       body, and also raises T4 cells even in people who are already
       taking AZT. Another protease inhibitor, when taken together
       with other anti-HIV drugs, dramatically reduces the amount of
       HIV in the blood.

       Epivir (3TC or lamivudine) is a new treatment, approved by
       the FDA for combination therapy with AZT. Ongoing studies are
       testing 3TC in combination with other anti-HIV drugs,
       including protease inhibitors.

       Saquinavir Fact Sheet: The first protease inhibitor approved
       by the FDA.

       Ritonavir Fact Sheet: This protease inhibitor was recommended
       for approval by the FDA, then fully approved within 24 hours.
       It's a potent drug that has been shown to prolong life and
       decrease the amount of HIV virus in the blood. A drug that
       people with less than 100 T4 cells should consider taking.

       Indinavir Fact Sheet: Although this protease inhibitor has
       not been tested in a large number of people or for a long
       period of time, the study results were promising enough that
       the FDA recommended the drug for approval.

       Viral Load Testing: A new type of test is being studied as a
       way to better measure whether or not a treatment is actually
       working.  Researchers hope these tests will help show if an
       HIV treatment is working. They also hope the amount of virus
       in the blood may indicate if someone should start or change
       to a different HIV treatment.

       Treatment Briefs

       Resources

       About the Network

       Network Publications

       Combination therapy advances

       Studies of anti-HIV treatment have been done, for the most
       part, in people with between 200 and 500 T4 cells. In the
       absence of any symptoms, this is thought to be a good time to
       start thinking about anti-HIV treatment.  The drugs most
       widely tested in this group of people are called nucleoside
       analogues. AZT, ddC, ddI, d4T and 3TC are drugs of this type.
       The body breaks down these drugs into chemicals that stop HIV
       from infecting uninfected cells in the body, but it does not
       help cells that have already been infected with the virus. As
       people with AIDS lose T4 cells - one of the immune systems
       main defenses - they become more likely to get infections and
       illnesses.

       In the past, people took one of these types of drugs at a
       time. Now, however, it is known that a combination of these
       drugs work better, even in people who have under 200 T4
       cells. There are several new drugs that can be used as part
       of combination treatment.  3TC, also known as Epivir or
       lamivudine, is in the same class of drugs as AZT, ddI, ddC
       and d4T. The combination of AZT and 3TC was recently approved
       by the Food and Drug Administration (FDA) for people with
       less than 500 T4 cells. Several studies showed that people
       who took this combination, even if they were already taking
       AZT, had increases in their T4 cells, as well as a reduction
       in the amount of HIV virus in their blood. Studies are being
       done to find out if 3TC works as well with other anti-HIV
       drugs.

       In addition, the combination of AZT and ddC (HIVID) was also
       recently recommended for full approval as combination
       therapy. Results of several studies showed that this drug
       combination slowed progression of HIV disease and improved
       survival, primarily in people who had never taken AZT before.

       A new class of drugs:

       Protease inhibitors are a long awaited, new class of anti-HIV
       drugs that block a part of the HIV virus called protease.
       Protease inhibitors force the HIV virus to make copies of
       itself that can't infect new cells. This is the first new
       class of anti-HIV drugs approved since nucleoside analogues
       (AZT, etc.). It seems likely that combination anti-HIV
       therapy will also include a protease inhibitor, although the
       decision to start taking a protease inhibitor should be well
       thought out.  Each recently approved protease inhibitor is
       described in this issue of Treatment Review.

       Protease inhibitors appear to cause less side effects than
       AZT type drugs, but each individual protease inhibitor is
       different. Like any other drugs, they all have potential side
       effects and may effect the way other drugs work in the body.
       The newly approved protease inhibitor, ritonavir, for
       example, can not be taken with the drug mycobutin. It is
       important to discuss potential side effects and interactions
       with a health care provider before starting to take any new
       treatment.

       Whether or not someone is able to take a protease inhibitor
       may also be determined by the kind of health insurance or
       assistance program a person uses to get medications. (Contact
       The Access Project at The Network if you need a referral to
       an ADAP in your state, or assistance accessing any
       treatment).

       The first protease inhibitor to be approved by the FDA is
       saquinavir (Invirase). Although this drug is not very well
       absorbed by the body -  a new version of saquinavir that is
       better absorbed is being studied - studies show that  the
       drug lowers the amount of HIV virus in the body, and
       increases T4 cells. People who are already on combination
       therapy might consider adding this drug to their treatment
       regimen, especially if the benefits of combination therapy
       seem to be wearing off. According to the makers of the drug,
       Hoffman-La Roche, taking saquinavir is not likely to spoil
       the benefits of taking other protease inhibitors in the
       future. This has not yet been proven, however.

       The protease inhibitor ritonavir (Norvir) was recently
       approved by the FDA. It is made by Abbott Laboratories.
       Studies show that ritonavir reduces the amount of HIV in the
       blood better than saquinavir. Ritonavir is the only protease
       inhibitor, so far, that has been shown to actually help
       people live longer. The study that demonstrated these
       benefits was conducted in people with less than 100 T4 cells.
       This is very good news for people already diagnosed with
       AIDS. It is not yet proven that the same effects will be seen
       in people with higher T4 cell counts.

       The third protease inhibitor, recommended for approval by the
       FDA, is called indinavir (Crixivan). Like ritonavir, this
       protease inhibitor appears to be more potent than saquinavir.
       All of the study results of indinavir have shown increases in
       T4 cell counts and a reduction of HIV virus. Although the
       studies of this drug have been very small, the results have
       been very encouraging. Hopefully, further studies will show
       that the benefits of indinavir are seen for a longer period
       of time in a greater number of people.

       Deciding which treatment to take

       The decision about which combination to take should be based
       on several factors, such as which combination has the best
       chance of reducing the amount of HIV in the body for the
       longest time, and which combination will best increase or
       keep the T4 cell count at its current number and hopefully
       prevent disease progression. Possible side effects of the
       drug combination, the number of pills that would need to be
       taken, and the kind of symptoms someone is experiencing, if
       any, should also be part of the decision making process. It
       is also important to think about what the other options would
       be if one combination stops working.

       Those who are currently benefitting from combination
       nucleoside analog therapy, and those who have not yet started
       combination therapy, may want to wait for more information
       before starting to take any protease inhibitor. Different
       combinations of protease inhibitors and nucleoside analog
       drugs are being tested in clinical trials. The Network has a
       current information on all combination therapy trials in our
       area, and a free handbook about the potential risks and
       benefits of clinical trials called "Should I Join An AIDS
       Drug Trial?"

       Protease inhibitors can have side effects. These seem to be
       seen less often than with the nucleoside analog drugs, but
       some side effects can be serious. Ritonavir, for example,
       blocks a pathway in the liver that is often used to clear
       drugs from the body. This effects the way other medications
       are processed in the body, causing drugs to get backed up in
       the liver. It is important to be carefully monitored when
       taking any new treatment. Protease inhibitors may also be
       rare side effects that have not yet been seen.

       Resistance is a big concern with protease inhibitors. It
       seems that the best way to avoid resistance is to take the
       drug on time, and not  to skip doses. Taking protease
       inhibitors in combination with other anti-HIV drugs has also
       been shown to slow down resistance. Researchers have been
       very clear about one thing: It is a very bad idea to stop
       taking a protease inhibitor once started.  Be well informed
       about the possible risks and benefits of any treatments.  If
       you have questions, ask your doctor or a health care
       provider, or call our national, toll-free phone number at
       (800)734-7104.

       AZT & 3TC

       Studies have shown that 3TC can raise T4-cell levels, and
       lower levels of HIV. More importantly, studies show that 3TC
       treatment may make AZT work better, even in people who have
       already taken AZT for a long time. 3TC has been approved by
       the government for use in combination with AZT in people with
       less than 500 T4 cells. The recommended dosage of 3TC is 150
       mg twice a day.

       Trial results:

       One trial compared AZT plus 3TC to AZT alone. Participants
       started with T4 cell counts of 100-400 and had taken AZT for
       less than 4 weeks at any time. After the first 24 weeks all
       participants switched to 3TC plus AZT for 24 more weeks.
       Increases in T4 cell counts were seen in those taking both
       drugs together. T4 cell counts rose an average of 85 cells by
       week 8 and 80 cells by week 24. Smaller increases were seen
       in those taking AZT alone.

       During the second phase of the study, T4 cell counts for
       those who had started on AZT alone and added 3TC increased by
       40 cells. Participants who took both drugs from the beginning
       had an average of 49 more T4 cells by week 48. Levels of HIV
       measured in the blood were reduced by more than 90% by the
       combination treatment. Only 5 people withdrew from the study
       because of side effects.

       Another trial compared AZT plus 3TC to AZT plus ddC in people
       who had taken AZT for an average of two years and had average
       T4 cell counts of 211. Participants taking AZT plus 3TC were
       divided into two more groups. One group took low-dose 3TC
       with the AZT, the other group took high-dose 3TC with the
       AZT. The participants in this trial had more advanced disease
       than those in the first trial. After 6 months of treatment,
       levels of virus measured in the blood were nearly the same in
       both groups on this trial. T4 cell counts rose an average of
       32 for the low dose 3TC combination, 15 for the high dose 3TC
       combination, and went down 15 for those taking AZT and ddC.

       Studies have also shown that 3TC reduces the amount of
       hepatitis B virus to where it can't be found anymore in all
       participants. Lasting results at the same dosage level were
       found in 6 of 22 patients over six months.

       Side effects:

       In studies, the side effects of headache, nausea and fatigue
       were all seen in more than a quarter of the people taking the
       combination of 3TC and AZT. Other side effects seen were
       nasal signs and symptoms, diarrhea, neuropathy (burning pain
       in the hands or feet), low white blood cells and anemia (low
       red blood cells). These side effects are sometimes seen when
       AZT is taken by itself. 3TC alone has few side-effects,
       mainly nausea, vomiting and headaches, and rare cases of hair
       loss.

       In children, 3TC can cause a side effect called pancreatitis.
       Pancreatitis is a dangerous swelling of an organ in the body
       called the pancreas. Children taking 3TC should be carefully
       monitored for this side effect.

       Resistance:

       HIV can mutate to try and resist the effects of 3TC within a
       few weeks after treatment starts.  But lab tests have shown
       that when the virus becomes resistant to 3TC, it is no longer
       resistant to AZT. It seems to take a long time for HIV to
       become resistant to both drugs. Virus that is resistant to
       3TC may also reproduce less well than normal virus.

       Access:

       Glaxo Wellcome Inc. has a patient assistance program
       for people having problems getting the drug. The number to
       call is (800)  722-9294. People that have been receiving the
       drug through the expanded access program and who now need
       help with reimbursement should call (800)  513-3028.

       Studies of 3TC in combination with other anti-HIV drugs are
       enrolling. Call The Network at (800) 734-7104 for a referral.

       saquinavir (Invirase)

       Saquinavir (trade name Invirase) is the first protease
       inhibitor to be approved for the treatment of HIV infection.
       Protease inhibitors are a new class of anti-HIV drugs. They
       work by blocking a part of HIV called protease. When protease
       is blocked, HIV makes copies of itself that can't infect new
       cells. Saquinavir has been approved for use by people with
       under 300 T4 cells, in combination with one or more of the
       approved nucleoside analog drugs (AZT, ddI, ddC, d4T and
       3TC). The current recommended dosage is 600 mg, three times a
       day.

       Trial results: In the largest clinical trial of saquinavir,
       the combinations tested were saquinavir/AZT,
       saquinavir/AZT/ddC, and AZT/ddC. After 48 weeks of treatment,
       people taking saquinavir/AZT/ddC had an average increase of
       111 T4 cells. People taking saquinavir/AZT had an average
       increase of 74 T4 cells. People taking AZT and ddC had an
       average increase of 72 T4 cells.

       Resistance:

       Studies have shown that HIV can become resistant to the
       effects of saquinavir. This happens because HlV makes more of
       itself all the time, and each new HIV virus that gets made
       can be slightly different. The type of protease that the HIV
       virus creates may be slightly different than the one it made
       before. The new protease that the virus has made may not be
       affected by saquinavir.

       If HIV becomes resistant to saquinavir, it may also be
       resistant to the effects of other protease inhibitors. There
       are two changes, called mutations, in HIV protease that
       saquinavir commonly causes. One of the mutations may make it
       easier for HIV to resist the effects of some other protease
       inhibitors. In one study, after a year of taking saquinavir,
       less than half the participants had any resistant virus.

       Saquinavir, in the current formulation, is not very well
       absorbed by the body. A small study done in California showed
       that the drug could have more anti-HIV effect when taken in
       higher doses. However, the doses used in this study would be
       very expensive and involve taking many pills every day. A new
       version of the drug is being tested that will hopefully be
       better absorbed. This new version of saquinavir will replace
       the current pill when the testing is completed.

       Studies have looked at ways to help the body better absorb
       saquinavir. Taking the drug after a full meal is strongly
       recommended. A small study found that ordinary reconstituted
       frozen grapefruit juice could help increase the levels of
       saquinavir in the body. People in the study drank a small
       (150ml) glass of the grapefruit juice with their saquinavir,
       followed by another glass an hour later. Drug levels were
       increased by about 50 percent. When people made the
       grapefruit juice stronger by mixing it with half the amount
       of water, the levels of saquinavir in their bodies doubled.

       There may be problems with using this method to try and
       increase the absorption of saquinavir. The grapefruit juice
       may affect other drugs you are taking, and this could be
       dangerous. The acidity of grapefruit juice may also irritate
       the stomach. If you are thinking of using grapefruit juice to
       boost the levels of saquinavir in your body, talk about it
       with your healthcare provider.

       Side effects: Compared to nucleoside analog drugs, saquinavir
       seems to have few side effects. In studies, the most common
       side effects, occurring in very few people, were diarrhea,
       stomach discomfort and nausea.

       Drug interactions: The antibiotics rifampin and rifabutin
       (Mycobutin) can greatly reduce the amount of saquinavir in
       the body. It is recommended that alternatives to these drugs
       are used if someone needs to take saquinavir. The anti-fungal
       drug ketaconazole slightly increases the amount of saquinavir
       in the body.

       Hoffman-La Roche, the company that makes saquinavir, has set
       up an assistance program for people that need help getting
       the drug. The number to call is (800) 282-7780. The hours are
       Monday to Friday, 9:00 AM to 8:00 PM EST.

       Studies are ongoing of the new version of saquinavir. Call
       The Network if you would like more information about these
       studies.

       ritonavir</a> (Norvir)

       Ritonavir (trade name Norvir, also known as ABT-538) is also
       one of the new group of anti-HIV drugs called protease
       inhibitors. Ritonavir is made by a company called Abbott
       Pharmaceuticals.

       Trial results:

       In a study in people with less than 100 T4 cells, ritonavir
       was found to help people live longer, and delay progression
       of disease. There were 1090 people in this study. The average
       T4 cell count was around 30. People were allowed to take any
       approved anti-HIV drugs while on the study. One group of
       people added ritonavir to the medications they were taking,
       the second group got a placebo or dummy pill.

       After an average of six months of follow-up, 46 people taking
       the placebo had died compared to 26 people taking ritonavir.
       This means that for people taking ritonavir, the risk of
       death was greatly reduced - almost halved - compared to
       people taking the placebo.

       The researchers also looked at the study results after just
       one month. At this point in time, 149 people taking the
       placebo had experienced a new opportunistic infection or
       died, compared to 69 people taking ritonavir. This seems to
       show that the drug can have an effect very soon after someone
       starts taking it.

       Other studies of ritonavir in combination with other anti-HIV
       drugs are ongoing. The full results of these studies are not
       yet known, although early reports are encouraging.

       The current recommended dosage of ritonavir is 600mg, twice a
       day. The drug should be taken with meals, if possible.

       Side effects: The major side effects seen in this study were
       nausea, vomiting, weakness and diarrhea. 91 people stopped
       taking ritonavir because of side effects, compared to 32
       people taking placebo. Other side effects that have been
       associated with the drug are numbing sensations around the
       mouth and elevated liver enzymes.

       Some of these side effects are thought to be caused by the
       bad taste of the current syrup formulation of the drug. This
       has now been replaced by a gelatin capsule.

       Drug interactions:

       Ritonavir can effect the way other drugs are absorbed by the
       body. There is a long list of drugs that may be affected on
       the package insert that comes with ritonavir. It is very
       important that anyone about to start taking ritonavir goes
       over this list thoroughly with their healthcare provider.
       Some of the potential drug interactions are potentially
       life-threatening. If you need help working out which drugs
       are on the interaction list (some drugs have several
       different names) call The Network.

       Not all protease inhibitors interact with as many other
       drugs. You may also be able to switch a problem drug so that
       you can take ritonavir.

       Availability: Ritonavir is now approved for the treatment of
       HIV disease and AIDS in adults. A study of ritonavir for
       people recently infected with HIV, and a study for children
       are enrolling. Call the Network for a referral.

       indinavir (Crixivan)

       Indinavir (trade name Crixivan, also known as MK-639) is
       another of the new group of anti-HIV drugs called protease
       inhibitors. Indinavir is made by a company called Merck
       Pharmaceuticals.

       Trial results:

       There is only limited information from trials of indinavir.
       All of the study results so far have been limited to changes
       in T4 cell counts and viral load (the amount of virus in the
       blood). The information that has been presented has also been
       from a small number of people.

       A study of the combination of indinavir, AZT and 3TC is
       ongoing. People in this study had been taking AZT for at
       least six months before they joined the trial. Participants
       were randomly assigned to indinavir/AZT/3TC, indinavir alone,
       or AZT and 3TC.

       After 16 weeks, 24 of the 26 people taking the triple
       combination of indinavir, AZT and 3TC had so little virus in
       their blood that it could not be found using the standard
       viral load test. This test cannot find less than 500 copies
       of HIV in a milliliter of blood. 13 out of 26 people taking
       indinavir alone also had less than 500 copies of HIV in their
       blood samples. No-one taking AZT and 3TC had the amount of
       HIV in their blood reduced below 500 copies.

       Some people in this study have now been followed for 24
       weeks. 6 out of 7 people on indinavir/AZT/3TC still have less
       virus in their blood than the viral load test can find. 4 out
       of 9 people on indinavir alone also have less virus in their
       blood than can be detected. No-one in the AZT/3TC group has
       undetectable virus.

       The median increases in T4 cells after 24 weeks were 146 in
       the indinavir/AZT/3TC group, 77 for the people taking
       indinavir alone, and 22 for people taking AZT/3TC. Other
       studies of indinavir seem to confirm that it has a strong
       anti-HIV effect. A small study combining indinavir/AZT/ddI
       found that people had a median increase of 90 T4 cells after
       24 weeks.

       It's important to remember that these results are from only a
       few people, and it isn't known yet whether they will be
       confirmed by larger studies. It is not yet proven that the
       drug will help people live longer or stay healthy longer.
       However, recent studies have found that reducing the amount
       of virus in the blood can also reduce the risk of disease
       progression and death. This leads scientists to hope that
       drugs like indinavir will help people stay healthy and live
       longer.

       Resistance:

       HIV can become resistant to the effects of indinavir. This
       has been seen in people in early studies where the indinavir
       dose was lower than the one now recommended. In these people,
       after 24 weeks on the study, levels of HIV in the blood
       returned to where they were before the study began. However,
       T4 cell increases averaging 80 to 100 were sustained for at
       least 52 weeks. This may mean that indinavir-resistant HIV is
       less harmful to the immune system than normal HIV. Further
       studies are being done to investigate this.

       Resistance seems to occur much more slowly at the dose now
       being used.  Using indinavir in combination with nucleoside
       analog anti-HIV drugs also seems to significantly delay HIV
       resistance to the drugs. Combinations of protease inhibitors
       are being studied, and should not be tried until results are
       known. Protease inhibitors could interact in ways that may be
       harmful to the body.

       Drug interactions:

       The antibiotic drug rifabutin (Mycobutin) can be affected by
       indinavir. It is recommended that people halve their dose of
       rifabutin when taking it with indinavir.

       Side effects:

       The most common side effects of indinavir are kidney stones
       and the temporary elevation of a liver enzyme called
       bilirubin. These have been seen in about 2-3% of people
       taking the drug so far. Bilirubin usually returns to normal
       levels on it's own. Kidney stones can be avoided by drinking
       plenty of water. It is currently recommended that people
       taking indinavir drink a quart of water a day.

       Viral load testing

       There are two kinds of viral load tests. The two tests
       measure what's called HIV RNA. RNA is the part of HIV that
       knows how to make more virus. One test, called the branched
       DNA test (bDNA), is made by a company called Chiron. The
       other is the polymerase chain reaction or PCR test made by
       Hoffman-LaRoche.

       Scientists have a good idea what some parts of HIV RNA look
       like. By creating a mirror image and matching it against what
       they find in someone's blood, they can find HIV RNA. The PCR
       test encourages the HIV RNA to make more of itself in a
       laboratory test tube. This makes it easier to measure the
       amount of HIV RNA that was in the blood sample. The bDNA test
       sets off a chemical reaction with the HIV RNA so it gives out
       light. Then the amount of light is measured in order to show
       how much RNA was found.

       The results of these tests are usually given per milliliter
       (ml) of blood, like the T4 cell count. The PCR test may give
       the amount per 0.05/ml, so you need to multiply the number by
       20 to get the standard result. Each virus carries two copies
       of RNA. If there are 100,000 copies of HIV RNA, that means
       50,000 viruses (often called particles or virions) are
       present. Currently, the bDNA test can't find less than 10,000
       copies of HIV RNA, but a recent improvement means it will
       soon be able to find anything down to 500 copies.

       Test results can be different, or variable, when repeated on
       the same blood sample. Any test results should say how
       variable the test might be. For example if the result was
       20,000 copies and the variability of the test was 5,000,
       you'd know that the result was somewhere between 15,000 and
       25,000 copies.

       There is still concern that there is a lot of virus in other
       places in the body, not just the blood. Only 2% of HIV is in
       circulating blood. The rest is in your lymph system and other
       body tissue. Also, measuring the good effect an HIV treatment
       has on the viral load doesn't take into account any bad
       side-effects the treatment might have on the body.

       Using the Test to Study a New Drug.

       Early viral load results from a large study of a drug called
       delavirdine have recently been released. This study found
       that the viral load test was a very good marker of disease
       progression. In this study of around 1,900 people, viral load
       was better than T4 cell counts at showing whether someone
       might be at risk for getting sicker. The study also found
       that if a treatment reduced the amount of virus in the blood
       by half, for as little as 8 weeks, the risk of disease
       progression was also halved. Scientists hope that this means
       that the kind of reductions in virus seen with newer
       treatments such as protease inhibitors will help people stay
       healthy and live much longer. With some protease inhibitors
       the viral load test has shown a 99.99% reduction in the
       amount of HIV virus.

       A Test of the Viral Load Test.

       A study of the viral load test is currently enrolling. People
       in the study will be divided into two groups. One group will
       make decisions about HIV treatments based on their viral
       load. The second group will make treatment decisions using
       their T4 cell counts and symptoms. In the guidelines for this
       study, it says that a viral load test result of over 100,000
       copies may mean that someone is at a higher risk for disease
       progression. A result of less than 10,000 copies is
       associated with a lower risk for disease progression.

       The guidelines also state that only a large change in viral
       load can be considered important. Anything less than a
       threefold change may be due to unimportant changes that occur
       with all kinds of tests. In addition, other infections such
       as a cold or the flu can cause a temporary increase in viral
       load.  If you are interested in taking part in the viral load
       testing study, call The Network for a referral.

       Currently, viral load testing is still experimental. Doctors
       can order them at a cost of about $200. However, it's hard to
       get an insurance company to pay for them. Medicaid will not
       cover them. It is likely that the tests will be approved for
       general use during 1996, once more results from ongoing
       research are available. More information on the
       Hoffman-LaRoche PCR test is available by calling (800)
       533-0567. The number to call for information on the Chiron
       bDNA test is (800) 642-4657 x2909. Reimbursement assistance
       for the Chiron bDNA test is available by calling (800)
       775-7533.

       Treatment briefs

       Agouron protease inhibitor:

       A new protease inhibitor called nelfinavir (trade name
       Viracept) is in clinical trials. One study is investigating
       nelfinavir in combination with d4T, compared to d4T alone. A
       second study will investigate nelfinavir in combination with
       AZT and 3TC, compared to AZT and 3TC treatment. Call the
       Network for a referral to the trial sites.

       Oxandrolone:

       The anabolic steroid oxandrolone (trade name Oxandrin) is
       available by prescription for the treatment of weight loss.
       This drug was approved in the 1960's for the treatment of
       weight loss due to chronic infection or trauma. In one study
       of oxandrolone as a treatment for AIDS-related wasting,
       weight gain was seen in people taking 15 mg a day for 16
       weeks. In people taking 5 mg a day, weight remained stable.
       People taking a placebo (a fake pill used in clinical trials)
       experienced weight loss. Oxandralone is a pill. This drug is
       not usually toxic to the liver, which can be a problem with
       other oral anabolic steroids. The drug also seems less likely
       to have a masculinizing effect on women than other anabolic
       steroids. The drug must be obtained direct from the
       distributor, Quantum Express. The number to call is (800)
       741-2698. Quantum Express can deal directly with your health
       insurance to help obtain reimbursement, and also has a
       compassionate access program for those that cannot afford to
       pay for the drug.

       The Access Project:

       If you're having trouble affording a treatment, the Network's
       Access Project has a database of federal, state and
       pharmaceutical industry programs that may be able to help.
       Call (800) 734-7104 for more information and referrals.

       DOXIL:

       DOXIL is a newly approved treatment for Kaposi's sarcoma, or
       KS. DOXIL is a liposomal drug. Liposomal drugs are standard
       chemotherapy drugs used to treat KS that are put inside
       microscopic bubbles of fat called liposomes. When the drugs
       are used this way, it is hoped they will have fewer side
       effects and be more effective. DOXIL is a liposomal version
       of the anti-cancer drug doxorubicin. The drug is given
       intravenously, which means via a tube placed into your arm or
       chest. The procedure takes 30 minutes, and is done once every
       three weeks. DOXIL has been approved for the treatment of
       advanced KS in people that have not responded to the standard
       treatment.  DOXIL is also recommended for people who can't
       take the standard treatments  for KS because of side effects.
       Very few people in DOXIL studies have had to stop treatment
       because of side effects. The main side effect is neutropenia,
       which is low white blood cells. Treatment with G-CSF, also
       known as Neupogen, can help lessen this side effect. Other
       side effects can be hot flushes, tight chest, difficulty
       breathing or swallowing and back pain. DOXIL can also cause
       heart problems, although this has not been seen as often as
       with standard chemotherapy. Sequus Pharmaceuticals, the
       makers of DOXIL, have set up a patient assistance program.
       Patient assistance programs help people having difficulty
       paying for a treatment. Call (800) 375-1658 for more
       information.

       The FDA recently approved a new kind of CMV retinitis
       treatment called Vitrasert.

       This is the anti-CMV drug ganciclovir, which is usually given
       by intravenous infusion, put into small plastic pellets. The
       pellets are placed into the eye during minor surgery that can
       cause distorted vision for two to four weeks. The pellets
       dissolve and deliver the anti-CMV drug directly into the eye
       for five to eight months, after which they can be replaced
       with new pellets.  People with CMV retinitis who use the
       pellets will most likely still need other CMV treatments to
       prevent CMV in other parts of the body. For full information
       about the drug cytovene in pellet, intravenous or capsule
       form contact Joy Schmitt at Hoffman-LaRoche at (201)
       562-2202. For information about the pellets contact Missy
       Lowery at Chiron Vision at (800) 352-1891.

       Network Resources

       The Network now has Simple Fact Sheets available on the
       following subjects: AZT, ddI, ddC, d4T, 3TC, protease
       inhibitors, saquinavir, indinavir, ritonavir, combination
       therapy, non-nucleoside reverse transcriptase inhibitors
       (NNRTI's), IL-2, oral ganciclovir, ganciclovir implants,
       anabolic steroids, thalidomide, HIV, MAC, Kaposi's sarcoma,
       cryptosporidiosis, fungal infections, and viral load tests.
       Call to order any fact sheet.

       The Network now has a home page on the World Wide Web called
       The InterNetwork. Expanded access programs and clinical
       trials are listed according to condition and are updated the
       minute we get any new information. Treatment updates and
       announcements,  as well as all The Network's publications are
       stored here, ready to be read or printed out. Our
       InterNetwork is part of being a Network member, so send in
       your annual $25.00 membership contribution now! Our home page
       address is: http://www.aidsnyc.org/network

       About The Network

       The information in this review is not meant to replace the
       advice or care of a medical professional. Always discuss your
       treatment options with a trained health care provider.

       We don't manufacture, test or sell any of these drugs or
       therapies. We do not endorse them, nor do we guarantee their
       safety or efficacy.

       Treatment Review is published 8 times a year. A $16.00 a year
       contribution is requested, but not required. A  $25.00 a year
       membership contribution is requested from all Network members
       and users. This donation greatly helps our run our day to day
       operations.

       Treatment Review is written and edited by Ken Fornataro and
       Richard Jefferys, with the assistance of Stephen Rehberg,
       Eddy Gordon Berroa, Lizzie Nevarez, Maximo Sepulveda , Felix
       Cruz, Nancy Fornataro, Bill Valenti, MD, Paul E. Cothran,
       Marlene Diaz, Rick Loftus, and many  friends and colleagues.

       If you want to copy, reproduce or excerpt this information,
       please give us a call at (800)  734-7104. This helps us to
       keep track of where and how this information is being used.
       Treatment Review and other Network resources are available by
       E-mail, and are on the Internet. Drop us a line at
       AIDSTreatD@AOL.com.

       The AIDS Treatment Data Network (The Network) is a
       not-for-profit, independent organization. We receive support
       for our work from individuals,  foundations, government, and
       corporations. We appreciate and encourage contributions for
       our work.

       In honor and memory of Robert D. Farber, our friend,
       colleague, artist, teacher, brother, and sponsor.
       Special thanks also go to the Farber Family, Fund for the
       City of New York, Hoffman-LaRoche, and The Ryan White
       Emergency Care Act of 1990, Title I.

       Network publications

       The Experimental Treatment Guide

       The Experimental Treatment Guide is a quarterly directory of
       experimental treatments in clinical trials, as well as other
       treatment programs in New York State and surrounding states.
       Includes a short version of the handbook, Should I Join an
       AIDS Drug Trial? . These publications are supported by The
       New York State Department of Health AIDS Institute. They are
       free of charge. A donation of $10 is requested if you are
       from out-of-state, or if you can afford it. Now available
       entirely in Spanish as La Gua de Tratamientos
       Experimentales!

       Treatment Review

       Treatment Review is the newsletter of the AIDS Treatment Data
       Network. Each issue includes descriptions of approved,
       alternative, and experimental treatments, as well as
       announcements of seminars and forums on treatments and
       clinical trials. Published eight or more times a year.
       $16.00. Publicado en Espaol como Resea de Tratamientos.

       Network Membership

       There is no charge to become a Network member, although many
       people support our work by making a yearly contribution.
       Individuals, service providers and clinicians, and
       organizations are asked to make a  yearly contribution of
       $25.00.  Members receive information about approved and
       experimental treatments, treatment counseling, referrals, and
       case management support. Professional members receive the
       same services and support for their clients and patients. You
       can contact us by phone, by mail, or by computer. We're
       interested in hearing your comments, and suggestions of
       treatments you would like to see written about in Treatment
       Review. Send us a request and we will do the research and put
       together a summary of that treatment. Our nationwide
       toll-free number is (800)  734-7104. Our New York City number
       is (212)  260-8868. If you have a computer and modem, our
       e-mail address is AIDSTreatD@aol.com.

       Copyright (c) 1996 - AIDS Treatment Data Network.
       Distributed by AEGIS, your online gateway to a world of
       people, knowledges and resources.  714.248.2836 * 8N1/Full
       Duplex * v.34+

