       Being Alive Newsletter
       People with HIV/AIDS Action Coalition * June 1995
       -------------------------------------------------

       Contents

       Inside...
       President's Notes			2
       Women's Conference			3
       Oral Ganciclovir			4
       Nutrition Power			6
       Partner Relationships		8
       Integrase Inhibitors			9
       Spanish Pages	                    10
       Fran McDonald	                    13
       Upcoming Activities	             15
       Support Groups	             16
       Bulletin Board	             17
       Announcements	                    20

       =========================

       * Correction *

       On page 3 of the April Newsletter, we printed Brent Grodeck's
excellent report on d4T (Zerit). The article originally appeared in
Positively Aware. In re-entering the text, we made an error in the
second paragraph.  It should read, "After two months of d4T therapy,
Alan's count rose from 189 to 237."  In one keystroke, we had
inflated the gentleman's T-cell count to 337. Our colleague Steve
McGuire, Positively Aware's editor, correctly points out, "An
increase of 48 cells is entirely within the range of typical
expectations for initial therapy with d4T. While an increase of 148
cells may not be unheard of, it would be unusual." We regret the
error and apologize for any confusion this may have caused our
readers.

       =========================

       Medical Update - June 26
       Mark Katz, MD

       General Update
       Dale Prokupek, MD

       Gastrointestinal Issues
       7 pm, Monday; Plummer Park, West Hollywood

       ==================

       Medical Update - May 22, 1995
       presented by Mark Katz MD and reported by Jim Stoecker

       ----------------------------------------
       Survival After CD4 Count Falls Below 200

       A recent report in the journal AIDS (February 1995) evaluated
579 men in the MACS study after their CD4 count dropped below 200.
(For those not familiar, MACS stands for Multicenter AIDS Cohort
Study and is a long term look at over 5000 gay/bisexual men in four
US cities.)  The subset studied were followed for three years after
their initial drop in CD4 count. Researchers found that 20% of the
group did not have an AIDS-defining condition at the end of the
three years. Some 28% of the men received an AIDS diagnosis within
one year of the study, and 29% within two to three years. The rest
of the group already had an AIDS-defining condition at the start of
the study period.

       Researchers noted that correlated with a longer time to an
AIDS-defining condition were slower declining CD4 count, higher body
mass index, and lower incidence of thrush. On the other hand, they
found no correlation between disease progression and use of tobacco
or alcohol or a history of sexually transmitted diseases. And
interestingly, they found that 45% of the men who remained AIDS free
used neither prophylaxis for opportunistic infections nor
antivirals.

       It should be noted that the researchers took their data from
the earlier years of the MACS study (which began collecting data in
1984). If we looked at the data today, one suspects that we would
see a different distribution than reported in this article and that
a larger percentage would be without an AIDS-defining condition.

       --------------------------------------------
       Stress as a Cofactor for Disease Progression

       What makes one person advance quickly to an AIDS-defining
condition while another person remains asymptomatic for years? What
are the cofactors for HIV disease progression? We know that age,
viral strains, and genetic factors are important considerations.
Common wisdom has said that stress might also be a cofactor, but
there has not been any proof of this.

       Now we read a study in the American Journal of Psychiatry
(April 1995) that appears to offer some proof about the effects of
stress on a person with HIV. In this study, 99 HIV+ men without
symptoms were compared to 65 seronegative men. In order to measure
stress, the researchers used a standardized test that identifies 111
so-called "stressors."  Each person in the study was rated on each
stressor on a scale of zero to four. Interviews were given over a
period of time; at the end of the study, each participant received
an overall stress rating.

       Not surprisingly, researchers found that the seropositive
group had a much higher stress rating overall than the seronegative
group. (We perhaps did not need a study to know this.)  What is
important is that they also found that those with higher stress
ratings had statistically significant reductions in NK (natural
killer) cells. This is the most objective data that we have to date
that stress does have an effect on T-cell function.

       ---------------------------
       More About Viral Load Tests

       Everyone at this point has probably heard about the new viral
load tests that measure the actual quantity of HIV in the blood.
Though these test are still experimental and are not yet approved by
the FDA, most studies underway are using this measure to help assess
efficacy. As study data are released, we learn more about the
significance of viral load measures. Is viral load a better
predictor of the course of HIV infection than the CD4 count? We are
beginning to learn more.

       A study in the Annals of Internal Medicine (April 15, 1995)
went back and looked at the plasma of 62 men whose dates of
seroconversion were known. Blood samples that were taken every six
months for 5 to 7 years were submitted to viral load testing.

       About a third of the men developed AIDS over this period; in
fact, 16 of the 18 in this group had high levels of viral RNA
throughout the testing period. Another third of the study group had
drops in CD4 count, while the remaining men remained stable
throughout the study period. Those in the stable group had
consistently low levels of virus, and 19 of the 23 in this group had
no detectable viral RNA. The researchers concluded that a viral RNA
count of over 100,000 per milliliter of blood was the most powerful
predictor of progression to AIDS.

       In a study published in the journal AIDS (February 1995),
researchers looked at 43 HIV+ people who were placed on ddI. They
determined the median drop in viral RNA for the group at the end of
one month of ddI therapy. In a long term look at the group, they
found that those with more than the median drop in viral DNA had a
median survival of 35 months from the start of the study. On the
other hand, for those whose viral load dropped less than the median
amount, the median survival was only 14 months.

       Both these studies point to the predictive value of viral
load testing. But these tests also have another important value.
They can tell us quickly if a particular antiviral regimen is
working for an individual. A study in the Journal of AIDS (April
1995) reports on 14 people who had at least 9 months of AZT therapy
and were switched to ddI. This group had a mean drop of 70% in viral
RNA after one year. Within this group, however, five had no drop at
all. These non-responders can now be identified so that a different
regimen can be tried. We all know that what works for one person
with HIV may not work for another. Viral load testing has the very
practical value of letting us quickly know what works and what
doesn't.

       -----------------------
       Some News on Antivirals

       We have explained before that two drugs can be additive (each
brings their own efficacy), synergistic (together they raise the
efficacy of each alone), or antagonistic (efficacy is reduced). In
combination antiviral therapy, we want to avoid antagonistic drugs
and search for synergistic combinations. In a study reported at the
recent Conference on Antiviral Research in Santa Fe, researchers
reported synergy in a combination of AZT and a protease inhibitor.
This was, however, a test tube study, but it does offer hope that
once protease inhibitors become available, we may have a powerful
combination to fight HIV.

       At the same conference, Burroughs-Wellcome reported on early
studies of its latest antiviral, 935U83. After 24 weeks of study, no
resistance has developed and side effects are less than what we have
seen with earlier antivirals. Researchers also report that in the
test tube the drug remains active against viral strains resistant to
AZT, ddI and ddC. We should be hearing more about this new antiviral
as testing continues. On the down side, Merck did report that when
resistance develops to its protease inhibitor, viral strains can
develop that are resistant to all protease inhibitors.

       --------------------------------
       Glaxo Limits 3TC Expanded Access

       As we reported some months back, the manufacturers of 3TC,
Glaxo Labs, put in place a program that made 3TC available to those
with less than 300 T-cells who had gone through AZT, ddI and ddC.
The response to this expanded access program apparently overwhelmed
Glaxo. They put a limit on new access to 350 people per week. If you
were caller number 351, you were placed at the top of the list for
the next week. Now, in a further effort to limit the number of
participants, Glaxo has announced that you must have less than 100
(rather than 300) T-cells to qualify for this program.

       --------------------------
       Protease Inhibitor Studies

       The Merck protease inhibitor is being studied locally at
Pacific Oaks and at Kraus Partners. For this available study, CD4
count must be between 50 and 500. Further, participants cannot have
used AZT prior to the study. This particular trial has three arms:
AZT alone, the Merck protease inhibitor alone, a combination of AZT
and the protease inhibitor. There is also another trial of the Merck
protease inhibitor for those who have been on AZT for at least 6
months prior to the study. Participants receive the Merck protease
inhibitor or a combination of 3TC and AZT or a combination of 3TC,
AZT and the protease inhibitor. We are not aware of local sites for
this particular study.

       Abbott Laboratories are sponsoring open label studies of
their protease inhibitor. One study is for those with less than 100
T-cells and previous antiviral therapy of more than nine months.
Locally, you can call either Cedars-Sinai (310.358.2300) or COMBAT
(213.469.5888) for more information. There is also a Phase III study
of Abbott's protease inhibitor (ABT-538) for those with 200-700
T-cells and no prior antiviral therapy. Participants receive ABT-538
or AZT or a combination of the two drugs. For information, you can
call COMBAT.

       SPV-30: Made in France and Testing in America

       Finally, we have news of a new drug called SPV-30 that is an
extract from the boxwood tree. This drug is made in France and a
phase I trial there showed an average CD4 count rise of 100 for
those on the drug and a drop of 50 for those on placebo. Noted
French AIDS researcher Luc Montagnier is very interested in this
particular drug and is planning more trials. Meanwhile, a study is
forming in the US. You can get a free six month supply of the drug
in return for providing regular blood work results to the
researchers. For information on this study, you can call David
Stokes in Boston at 617.424.9195.

       ==================
       President's Column
       by Walt Senterfitt

       Being Alive Brings Phone Service to LAC/USC AIDS Patients At
long last, on May 20, private bedside telephone service was
inaugurated in Ward 6700, the inpatient AIDS floor of LA County/USC
Medical Center. Previously, the only phone service available was one
instrument at the nurses' station and one pay phone in the corridor
outside the wall.  Often, patients are too ill to walk out to these
phones, where they face a waiting line anyway.  Now, each patient is
given his/her own private number at the time of check-in to the unit
and can make unlimited local area calls and receive calls from
anywhere. It is the only bedside phone service anywhere in the
sprawling county hospital, the largest in the nation.

       The new service is a cooperative venture of Being Alive and
the Disney Company, brought together by the Community Advisory
Committee for AIDS Care at the medical center.  Our Board voted
nearly two years ago to explore establishing this service, after
noting how often our members and other PWAs become isolated in the
hospital at the very time when contact with friends and loved ones
can be most precious.  The contributions to Being Alive in memory of
my late lover and Being Alive volunteer  (and LAC/USC client), Jorge
Correa, were dedicated to this project.

       Numerous delays and complications arose.  Finally, another
client persuaded his former employer, Disney, to donate necessary
equipment and labor through their telephone services supplier. Being
Alive paid for the start-up costs for the 20 phone lines and will
pay the monthly basic service charges, as well as expanded
metropolitan area service from northern San Diego to southern
Ventura Counties.

       We committed ourselves to underwrite the service for at least
one year.  We will evaluate the effectiveness and the costs after
six months, and then decide whether we can continue to pay it out of
our general funds, or whether we need to establish a special general
community fund.  Early returns from the patients show enthusiastic
support and gratitude.  They couldn't believe that they would get a
service "just like in a real hospital"!

       For me, it's personally gratifying to bring to fruition a
memorial to Jorge, who fought with dignity for life and for the
right to decent health care for himself and his Latino brothers and
sisters. It makes me proud to be associated with Being Alive. It is
another example of our fulfilling a part of our mission statement:
"Being Alive is the means we have created to help us connect with
each other, bring others like us out of isolation, and take charge
of our lives, our care and our destiny."

       ----------------
       Keith Brier Dies

       It is with sadness I inform you of the passing on June 1 of
former Board member and active volunteer Keith Brier.  Keith came
around Being Alive after several years of intense depression
following the loss of his lover. He gradually found a home here, and
pitched in with his diverse skills, particularly in computers and in
task organizing. He was the lead volunteer for the Connect!
newsletter.  He helped set up our computer network.  He organized
the spectacularly beautiful Christmas party at Castle Green in
Pasadena in 1993, and advised the following year's committee on how
to replicate and surpass the first event.  He helped bring pressure
to bear on APLA to become more sensitive to and inclusive of its
clients and the entire HIV-community.  He made contributions to
other organizations as well, LA Shanti most notably.  We will miss
him.

       ----------
       CSW Parade

       Being Alive will have a splashy contingent in the annual CSW
Parade in West Hollywood on Sunday, June 25.  We won't have a float
this year, but we will have convertibles and jeeps to ride in, with
banners, signs and energy.  We will have an active booth at the
festival throughout the weekend, and can always use more volunteers.
Join us! Call Being Alive's Silver Lake office for more details.

       ========================================
       National Conference on HIV/AIDS in Women
       An Overview
       by Walt Senterfitt

       The Second Conference on HIV Infection in Women, held in
Washington, D.C. earlier this year, underscored two essential facts,
one painful, one hopeful. Laboratory and clinical research on HIV
infection in women is several years behind information about men.
"Old-fashioned," heartfelt, "in-your-face" activism is alive and
well among the increasingly conscious communities of women living
with HIV/AIDS.

       Women Alive was responsible for organizing and raising funds
for a delegation of 35 HIV+ women from Southern California-by far
the largest single contingent of positive women at the Conference.
Some were veteran activists; many were attending an AIDS conference
(and visiting Washington) for the first time. Their presence was
felt throughout the Conference. Mary Lucey was a keynote speaker at
the opening plenary session,  a frequent speaker from the floor
microphones in various sessions and a tireless leader of her
delegation throughout the Conference.

       ----------------
       Plenary Sessions

       The featured keynote speaker at the opening plenary was
Patricia (Patsy) Fleming, President Clinton's new Director of
National AIDS Policy (once known as the AIDS czar or czarina). She
had a tough row to hoe, trying to defend the disappointing record of
her boss and minimizing the controversy over mandatory testing of
pregnant women. The other bureaucrats and some researchers in the
audience cheered Fleming, whereas most of the infected women and the
more activist researchers sat on their hands and let out occasional
groans and hisses. She angered everyone by leaving the room
immediately after she spoke, which just happened to be immediately
before activists Maxine Wolfe and Mary Lucey spoke forcefully. A
subsequent statement of the entire Conference steering committee
chastised her for this act in strong language.

       Also impressive at the opening were talks by Kathy Anastos of
the Bronx and Mardge Cohen of Chicago, both prominent women
physicians and researchers in large county hospitals treating large
numbers of positive women from impoverished communities. It is clear
their hearts and minds are with their women patients and with the
activists, rather than with the bureaucrats or their more privileged
and conservative colleagues (male and female). They each spoke out
clearly against using the ACTG 076 results as the basis for a new
mandatory testing campaign, on grounds of both science and public
policy. The presence and message of Anastos and Cohen underscored
their role in an alliance between infected women and their advocates
on the one hand, and women (plus a few male) doctors on the other.

       -------------------------------------------------------
       Do Women With HIV Get Sick Faster and Get AIDS Quicker?

       Unfortunately, solid answers to this question must await
further data from two recently-initiated natural history studies of
HIV infection in women. These studies, known as "HERS" and "WIHS,"
are patterned after the 10-year-old MACS study in men (and many
similar male cohort studies). HERS had some very preliminary data to
report; WIHS is still enrolling. Both were begun several years later
than they should have been, and then only because of relentless
pressure from women activists and their small band of supportive
researchers.

       Several smaller studies tended to answer the above question
"No." If women have similar access to health care as do the men
they're compared to, they get sick or get AIDS at about the same
rate as men. In a Baltimore study of men and women getting care in
the same clinic between 1989 and 1993, men took an average of 2.8
years to progress from early symptomatic disease to AIDS; women took
slightly longer, 3.1 years. The median survival time after an AIDS
diagnosis was identical for men and women, 1.8 years. Both studies
noted some differences in the incidence rates of AIDS-defining OIs.
More men presented with PCP, more women with esophageal candidiasis.
In non-AIDS-defining symptoms, more women had sinusitis and genital
warts, whereas more men had skin diseases and oral hairy
leukoplakia.

       A larger but less well-controlled study reported that the
women were likelier than the men  to die from their first OI (which
was most often bacterial pneumonia). However, for those who survived
their first OI, the women progressed more slowly and lived a little
longer. The worse mortality in the initial episode was attributed to
the fact that more of the women had a history of active IV drug use,
and in general had less access to health care.

       Another study of positive women in the military found that
about 5% were "long-term non-progressors," that is they had
documented HIV infection for at least seven years with no symptoms
or T-cell decline. This is about the same as among similarly
cared-for men.

       ----------------------------------
       Do Women Lose Less Lean Body Mass?

       Results presented conflicted with each other. Don Kotler's
group in New York found in a smallish retrospective study that 40%
of the weight loss among men was due to loss of lean body mass vs.
only 8% among women. They concluded that women lose proportionately
more body fat and less lean body mass than do men. The pattern
suggested that weight loss in women may be partly due to low levels
of sex hormones, analogous to the relationship of low testosterone
levels to loss of lean body mass in men.

       An ongoing prospective study in San Francisco, however, found
no such difference. This study found that women lost lean body mass
to the same degree and in roughly the same pattern as men.

       ---------------------------------------------
       Do Positive Women Get More Genital Infections
       Than Negative Women?

       Several studies compared the incidence of syphilis,
gonorrhea, chlamydia, trichomonas, candida (yeast) and bacterial
vaginitis in HIV+ women to control groups of HIV- women. Only
candida vaginitis occurred more frequently among the positive women.

       ----------------------------------------
       Does Pregnancy Drive T-cell Counts Down?

       According to a longitudinal study at the University of Miami,
single or multiple pregnancy had no effect on CD4 or CD8 counts. The
counts declined at the same rate in women who were pregnant as in
those who were not. Further, there was no difference in rate of
progression to AIDS. Are Pap Smears Good Enough Screening For
Cervical Disease?

       Ample evidence has been reported on the association between
HIV infection and the risk of cervical cancer and precancerous
growths (the latter known as CIN, cervical intraepithelial
neoplasia). The lower the CD4 cell count and function, the higher
the risk of CIN. It is important to know whether regular Pap smears
are adequate monitoring for CIN, or whether the more invasive
colposcopy is necessary. The jury is still out on the question.
Latest results from an ongoing cohort study presented at the
conference shed light on, but did not answer, this question. A group
at Columbia University in New York has been following two groups of
400 women (one group HIV+, the other HIV-) every six months since
1991. Overall, 20% of the positive women have had CIN, compared to
4% of the negative women. The annualized incidence rate of new cases
of CIN was 8.1% among the positive women and 1.1% in the negatives.

       Pap-smear screening correctly identified 81% of the true CIN
cases, and correctly labeled as non-CIN 87% of the true non-cases.
These rates are decidedly less than optimal, but are comparable to
many previous studies of Pap-smear effectiveness in uninfected
women.

       ------------------------------
       Mother-To-Infant Transmissions

       This was one of the hottest topics of the conference, because
of the current controversy over the results of ACTG 076 and the move
to mandate HIV testing for all or "at risk" pregnant women (see
related articles in Spring 1995, Women Alive  and March 1995, Being
Alive newsletters). The scientific reports at the conference
emphasized that there are a number of factors involved in whether or
not HIV is transmitted during a particular pregnancy or childbirth.
These factors include viral load, previous use of antiretroviral
drugs, AZT resistance, Vitamin A levels and the quality of prenatal
care available. Collectively, these studies argue strongly against
the current simplified message being touted by media and clinicians
alike ("AZT in pregnancy prevents infection of babies"). It argues
for the more logical and empirical proposition that minimizing risk
of vertical transmission requires use of a variety of strategies,
individually tailored to the status and history of the particular
pregnant woman.

       ----------
       Conclusion

       The closing plenary featured a government doctor/official,
Felicia Stewart, summarizing the research and action remaining to be
undertaken on behalf of women. She was somewhat less defensive and
more honest than Fleming was at the opening. However, far more
moving was a tub-thumping, grassroots speech by the head of a
community-based outreach organization in Atlanta, Sandra McDonald.
She brought the infected women in the audience to their feet with
her message of mutual self-help and partnerships with our
communities. Our marching orders following the famous axioms of
Frederick Douglass, "Power concedes nothing without a struggle," and
Mother Jones, "Don't mourn, organize!" Thirty-five "Women Alive" and
one representative of their male comrades-in-arms returned to LA in
high spirits, with renewed energy and some newly-minted activists
among us.

       ====================================================
       How You Can Get Oral Ganciclovir for CMV Prophylaxis
       And Other Things Roche is Doing
       by Walt Senterfitt

       The Roche pharmaceutical company, also known as Hoffman
LaRoche, held another in their series of briefings and consultations
with AIDS community treatment activists and reporters last month in
San Francisco. Being Alive was there. We pass along the most
interesting bits and pieces we heard.

       -----------------------------
       CMV Treatment and Prophylaxis

       Roche recently purchased the Syntex drug company, which
developed ganciclovir (GCV) as the front-line treatment for CMV
retinitis and other sites of CMV disease. Until recently,
ganciclovir had to be administered intravenously. An oral form of
the drug, hampered by its poor absorption in the intestine, was
nevertheless found to be almost as effective as the IV form in
preventing recurrences of CMV retinitis. The FDA approved the
marketing of oral ganciclovir (trade name Cytovene) as maintenance
therapy for CMV retinitis in January of this year. This was and is
good news for people who would rather run the risk of somewhat
faster recurrence of symptoms in exchange for not putting up with
the inconvenience and infection risks of a PICC or Hickman catheter
and regular IV infusions. Another form of ganciclovir, intravitreal
implants, is currently in clinical trials and promises to be at
least as good as the oral form in preventing recurrent retinitis. A
tiny capsule of the drug is inserted in the eye under local
anesthesia and is slowly released into the fluid which bathes the
retina.

       It makes sense that this method might be the most efficient,
permitting much less of the drug to reach the bloodstream where it
causes in some people the serious side effect of lowering the white
blood cell count. The flip side of this advantage of localization is
that the drug would have little chance to fight symptomatic CMV
infection in other organs of the body. While less common than
retinitis, CMV can also cause colitis, pneumonia and disease of the
gallbladder, liver and kidney.

       The implants are currently available only at institutions
enrolled in a formal clinical trial. For information on the nearest
one to you, call Ronnie Chin at Syntex, 415.852.1392.

       Returning to oral ganciclovir, we were all heartened last
summer by the news that when taken prophylactically, this drug
prevented about half the cases of retinitis that would otherwise
have occurred in a given time period. Roche, however, decided to
delay asking the FDA approval for marketing of oral GCV. They felt
they needed more data than the one completed study and did not want
to complicate the application for oral GCV as maintenance treatment.

       Some people have already to begun to use oral GCV for
prophylaxis, especially those with private physicians and generous
insurance policies. Since the drug is FDA-approved and on the
market, a physician can legally prescribe it for anyone. This is
known as "off label" prescribing. However, it is very expensive, as
much as $50 for a day's supply. (Needless to say, we activists took
the company to task in no uncertain terms for this outrageous
pricing.) In these days of managed care and cost containment, the
majority of people do not have access to oral GCV for prophylaxis
until and unless it becomes approved by the FDA for such use, and
insurers, HMOs and Medi-Cal (Medicaid in other states) agree to pay
for it.

       But wait, there's a way around this obstacle right now. Roche
is conducting what they call "An Open-Label Study of the Safety of
Oral Ganciclovir for the Prevention of CMV Disease in People
Infected with HIV." Open-label means there is no blinding or placebo
involved; everyone gets the drug. What this amounts to is a form of
"parallel-track" trial of the drug, which in turn amounts to free
expanded access-if your physician or clinic is willing and able to
do the necessary paperwork.

       Enrollment is open through any licensed physician in the U.S.
The doctor or clinic must complete registration procedures with
Syntex and agree to submit regular report forms. The company claims
the data collection required of the doctor is minimal, except that
they need complete information on any changes in dose and any
adverse side effects. An eye exam is required at the time of entry
into the program, and doctor's visits are required every month for
the first two months and then every two months. (This last bit
doesn't seem too burdensome, because people at severe risk for
retinitis are probably visiting their doctor at least monthly
anyway.)

       To be eligible, a person must be 13 or older, have less than
50 CD4 cells, be CMV positive by culture or blood test, have no CMV
retinitis, have no other CMV disease which has required treatment in
the preceding 30 days, have an Absolute Neutrophil Count (the kind
of whiteblood cells which fight off most bacterial infections) of
more than 750 and a platelet count of more than 50,000, and have no
history of hypersensitivity to acyclovir or ganciclovir.

       Enrollment is limited to 5,000 patients, but so far they've
only enrolled 150 in the first two months. For information, call or
have your physician call the Syntex Study Center at 800.569.4630.
Roche's Protease Inhibitor

       Saqinavir (trade name Invirase), Roche's protease inhibitor,
is the furthest along in development of any drug in this new class.
They plan to file an FDA application for accelerated approval in
late 1995. Questions remain about its relative effectiveness,
compared to other protease inhibitors, and about the optimal dose.

       Trials are underway at Stanford with a daily dose three times
higher than that used in other clinical trials, which showed the
drug moderately effective when used in combination with a nucleoside
analog reverse transcriptase inhibitor (like AZT, ddI, ddC, d4T, and
3TC). They are also testing a new formulation of the drug that makes
it better absorbed in the intestine.

       Despite these uncertainties, the group of activists at the
San Francisco meeting, when asked by Roche, strongly and unanimously
supported the company's applying for accelerated approval as soon as
possible. (At the same time we could not promise, of course, to
recommend it highly once it's on the market. That depends on the
alternatives available at that time and on new data on saquinavir as
it becomes available. But we sure as hell need the drug readily
available for those whom it might benefit.)

       Roche announced at this meeting that they will begin an
expanded access program for saquinavir in "the third quarter of
1995," that is sometime between July 1 and September 30. Expecting a
huge demand, they will limit the program to 4000 people, using a
lottery if necessary. (The drug is quite expensive to manufacture,
according to the company.) The program would have minimal
eligibility requirements, basically open to anyone with a declining
CD4 count of 300 or less who is not eligible for any open clinical
trial of the drug. There will be no restrictions on what else a
person is taking or not taking.

       -----------------------------------------
       PCR Technology for Viral Load Measurement

       Roche owns one of the two technologies now being widely used
experimentally to directly measure HIV viral load. The other, bDNA,
was developed by the biotech company Chiron. Roche's test is based
on PCR (polymerase chain reaction) which amplifies HIV RNA many
millions of times and then counts it. In retrospective analysis of
some clinical trial data, those participants whose viral load (as
measured by the Roche PCR test) dropped sharply soon after starting
a new antiviral drug were the ones who ended up having clinical
benefit from the drug. In other words, the test tended to
distinguish those who would live longer or get extra time without an
OI from those who wouldn't.

       Since retrospective data can be misleading, prospective
clinical trials are underway currently to see if this predictive
power still holds. If it does, then it may well indicate that those
whose viral load doesn't drop quickly should not waste time and put
up with side effects but should instead try something else.

       Many believe that the viral load test may be of even broader
benefit in individualizing treatment. Assuming regular monitoring as
is now done with CD4 counts, when viral load starts to rise it may
mean it's time to switch drug regimens or add a new one to the
"cocktail."  Similarly, we may be able to figure out very quickly
whether the new regimen is working, without waiting for CD4 changes
or the development of new symptoms.

       However, this hope has yet to be confirmed in practice. It
was rather disturbing that Roche did not have underway any tests of
this individualization strategy.  We'd bloody well better have some
evidence that it's worth it before we recommend that everyone add
this expensive new test to their regular care and disease
management, and thus dump millions into any company's coffers. It's
expensive, and we'll have another fight on our hands to get
insurers, HMO's and Medi-Cal to pay for it.

       I will say for Roche scientists and managers that they
immediately realized this weakness in their development plan, and
invited the community to help them come up with practical,
beneficial testing strategies. I got a call the next day from the
senior scientist in charge of developing their PCR test kits, and
I'd welcome the help and advice of anyone interested. They are in
discussion with the FDA about what exactly will be required for
approval of the kit (to be used by any lab with PCR capability) and
of their parallel plan to market the services of their diagnostic
laboratories to do the tests centrally. They hope to apply for FDA
approval sometime before the end of 1995.

       ------------------
       Concluding Thought

       I realize much of this report is technical and arcane unless
you've been following it, but it is interesting to follow how the
drug development and marketing process works in practice. Roche has
come a long way in opening itself to community input and dialogue.
If you want to get involved in this particular process or in similar
ones concerning other drugs and companies, consider joining our new
treatment study and action group. I'm jocularly referring to it as
the "Being Alive Irregulars" (with apologies to Arthur Conan Doyle),
and it's just about to leap off the drawing boards. Watch for an
announcement of the first meeting.

       =========================
       Travelling with HIV
       by Jennifer Jensen, MS, RD

       -------------
       Summer Travel

       Last year, Positively Aware's Timothy Frick quoted Ernest
Hemingway when he characterized the Paris arts community as a
"moveable feast."  If you are travelling to Paris, however, and you
feast on the wrong French pastry, the movement you experience may
not be an artistic one!  Food for thought? Summer vacation is here
and that means that people living with HIV are well advised to start
getting "appropriately neurotic" about food safety concerns. We do
want you to get back home in good health, well fed, and without any
travellers' diseases. Also, it's a bummer to find yourself sick and
in bed while taking the vacation of your dreams -- because bad food
got to you before the fun started.

       Here, then, are some reminders on how we really can have it
all and remain in good health. But it's like everything else in
HIV-life; travelling and staying well is more of a job and much more
tedious than for HIV-negatives. One trick that may be helpful is to
behave as if your vacation dreamland is like a third-world country;
all bets are off -- assume that most of the food you find there is
suspicious, and act accordingly.

       ------------------------------------
       Preparing to Travel: See Your Doctor

       Being prepared's first consideration, and a suggested
travel-safety requirement, is a visit to your doctor. Tell this
member of your healthcare team where you're planning to go, and
discuss any prophylaxis that may be warranted to make sure you
return home safely and, of course, to maintain your "personal best"
health while you're away. This medical visit should occur, ideally,
about six months prior to your planned excursion -- but ideal timing
notwithstanding, always better late than never!  Call today! If your
travel involves a foreign country (especially Mexico and other
"south of the border" vacation sites), medical prophylaxis may be
indicated. Often Bactrim is the preventive of choice, but many of us
are already using this agent for PCP prophylaxis. If that is the
case, or you can't tolerate Bactrim, a different preventive
antibiotic may be recommended. Call your doctor.

       Start preparing early!  If you need preventive antibiotics
for "travellers trots," it may be wise to try for tolerance to other
preventive options like Ciprofloxacin, Norfloxican, or other
remedies. Since many antibiotics can trigger allergic reactions, a
"tolerance test" may be indicated. Please don't assume that you're
safe just because you're travelling to a familiar location. The
transportation experience itself may pose risks-read on. When
travelling to some countries, vaccinations may be required. Included
in this list,you may need inactivated versions of polio and typhoid
vaccines, hepatitis preventives and perhaps the
"measles/mumps/rubella" triple-combo protection. Also, depending on
your destination, protection from  cholera, rabies, and plague and
yellow fever may be warranted. Don't tempt fate:  prevent any
uninvited medical condition for which there is a safe vaccine. Take
the protection approach and do as your doctor advises.

       Your prescription medications should be going with you, and
preferably in their original containers (so as to avoid going to
jail). Discreetly packed prescription bottle labels may help out
with this situation. If your destination is not an HIV-friendly
locale, although we'd never encourage you to fib a bit, you may want
to use a creative success approach: Put meds into vitamin bottles
and, of course, include the vitamins too. Get a list of medical
services and with luck, the names and numbers of HIV-savvy doctors
along the way to your destination.

       Other sources of information on vacation safety are
available. You may wish to call the country's embassy in Washington,
D.C. or its local consulate to find out their policy on tourism and
immigration for HIV+ travellers. The place you want to visit may
have restrictive immigration policies, while other destinations may
be more HIV-friendly. Another good information source is the Centers
for Disease Control (CDC) in Atlanta. Calling them at 404.332.4555
is a good safety idea.

       -----------
       On Your Way

       Travel by plane may pose health problems. Airplane food is
usually sufficiently awful that not eating it shouldn't be a
problem. However, if you do like the air-fare, don't eat anything
unless it's hot; cold airplane food  may pose very real safety
risks-regardless of HIV status. It's been reported that on some
flights HIV-negative cold food eaters have gotten sick-probably from
neglected meats, lettuce, mayonnaise, or just plain sloppiness.
Rolls and breads are usually OK, but don't trust the junk they send
with it-eat it plain on the plane. And otherwise eat hot food
offerings.

       Another important consideration about air travel is
recirculated air, which may pose health risks. A risk that you may
be able to avoid is the "droplet" type of  infection. Suppose you're
seated near a coughing person. You may never know why the person is
coughing, but if he or she is seated near you and has anything from
a cold to pneumonia to tuberculosis, they can potentially spread
germs to nearby passengers. Should you find yourself in such a
situation, request reseating. If this means disclosing a health
condition, and if you don't want to disclose your HIV status, you
could claim that you're going through chemotherapy or organ
transplantation-there's less stigma around those conditions and the
possibly homophobic/AIDS-phobic crew and passengers won't be as
likely to discriminate.

       It's your call; say what they need to hear!  Maintain your
anonymity. More than likely, your sky host or hostess will be happy
to oblige your request. Did I say demand to be reseated?  Take it to
the cockpit crew if you must. You do want to return from your
travels unharmed?

       -----------------------------------------
       Land Travel (Car, Bus, Train, and Trails)

       Being prepared here is inspired!  We can always take safe
food along for the ride. It's not expensive to get a cooler
(whatever suits your needs and space-from very small to quite
large).

       Taking your food with you saves quite a lot:  Money for
one-from fine restaurants to roadside diners, the food is more
costly than your "bring-along" fare. Your major expense may be
buying ice-good advice-lots of ice.

       Nice things to keep on ice might include sandwich fixings.
Breads and rolls are usually safe for a day or two with or without
ice, but what goes into the sandwich may not be. Tuna sandwiches can
be great-and are a good health choice too. Keep everything for this
sandwich in your cooler. Small 3.5 ounce tuna cans are a
nearly-perfect sandwich size container (fish-oil power!). Add
mayonnaise, maybe some chopped up hard-boiled eggs (protein power!),
tomato slices (vitamin C power!), avocados (calorie/nutrient
power!), onions (flavor power!), and maybe even some water chestnuts
(crunch power!).

       Other nice ice things include potato/pasta salads, yogurt,
peanut butter, carrot sticks, cottage cheese, cole-slaw, avocadoes,
grapes, apples, oranges, peaches/nectarines, pears, bananas and
other assorted fruits and vegetables.

       If you have diarrhea, leave out most of the vegetables and
peel the fruits if you can (a knife for peeling is an easy-to-pack
tool). If your produce has seeds (eg. grapes, berries, tomatoes)
this might not work too well on your food-bringing list. Canned
fruits often travel even better than fresh-they don't need ice, they
won't rot on you, and since you may not be able to buy fresh produce
during your "dream" trip, packing in some canned goods may be just
the thing for this vacation. Many food-peeling knives come equipped
with can opener options too!

       Yogurt (protein and calcium power!) and multi-packs of chips
(with dips from the cooler) can be good snacks, and trail mix
(calorie, mineral and vitamin power!) can come in handy too. Pureed
foods often work well; already pre-packaged and safe, they can be
found in the baby-food aisle of your market. If the aisle also has
some Infalyte, pick up a bottle or two-just in case diarrhea
happens.

       -----------------------------------------------------
       Three Words may save your vacation:  Heat Kills Germs

       If food or fluids have been heat-treated (like distilled
water, for example), you have a guarantee of automatic safety-unless
someone else exposed it to germ warfare. Take your own "safe water"
or canned sodas. Whether in the Third World or the Great Plains,
water safety is a must!  If you don't have access to distilled
water, boil your own.

       A lot of fluids are available packaged in "tetra-brik" boxes.
This is a very user- friendly and packing-friendly container type.
Risk of spillage is very minimal, the packaging is safe enough to
not require refrigeration, and you'll always have "safe fluids" to
drink. If in a restaurant, you may want to drink this beverage from
a glass-just request a "no-ice" clean glass. A news report from June
1 (1995) gave municipal water standards a huge thumbs-down. Across
the country, expect that water from the tap is deadly - boil it and
it's safe. Heat kills germs. If you're in a foreign country, be
especially careful-drink sodas from the bottle or can, and wipe the
lip surface with a wet wipe-a good thing to have with you no matter
how far from home you go.

       One client recently took off for a backpacking trip with
plans for campfire-based water boiling and lots of powdered
supplements, including single- serving size mixes such as Met-RX,
(available in many pharmacies), cheap and easy instant breakfast,
and dehydrated soups. Instant oatmeal and other single-serving
packets are easy to pack, lightweight, and safe when made with hot
water. Clintec Nutrition company has just introduced a "New Basics"
product line including soups (tomato and chicken), and really
good-tasting chocolate bars. Also, NCI has NuBars in coffee crunch
and vanilla caramel flavors. Pre- packaged individually, these meal
augmentations can help with fatigue prevention and weight-loss
protection. For this trekking-type of vacation trip, insect
repellant is an important provision. Dr. Jeffery Karaban, a
dermatologist, warns that people with HIV get bigger, more itchy
bites-and these, in turn, may require high-potency cortisone
treatments as well. He adds that we're also more sensitive to sun
exposure, especially if taking Bactrim or other antibiotics.
Decreases in CD4 counts have been noted after significant sun
exposure.

       ----------
       About Meat

       Well done is the request of choice, relying on the fact that
heat kills germs. If the meat is well-cooked, the bugs are dead. If
the meat is slightly rare, send it back-tell them you just love
well-done meats. Be especially careful about ground meat like in
hamburgers. Here, the meat cannot have even the tiniest bit of pink.
E. coli has recently been reported to have caused some deaths, as
well as a lot of harm to HIV-negative people. That same harm could
be even more costly with HIV positivity inmind.

       If fish is for you, double your demands for doneness. Just
knowing about our globe's polluted waters may be enough to cause
avoidance behavior, but if you need fish, it must be flaky. If
there's even one little "soft-spot" it's too suspicious to eat. Send
it back for better cooking.

       The same applies to poultry. Even in the US, poultry can be
hazardous to our health. Away from home, the risk goes up the
further into the third world you get. From Mexico to Morocco, you
may assume (usually correctly) that poultry has been stored and/or
prepared un-hygienically.  If there's the tiniest bit of pink near
the bone (check this out before you begin to eat), send it back.
Contaminated food that you don't eat won't hurt you. Don't be afraid
to demand safety. You'll be happier spending your vacation traveling
and enjoying your vacation paradise of interest rather than just
looking at it through your hospital window. By the way, no matter
where you are, hospitals are not germ-free environments-just being
in one can add to your risk of contracting bacteria, parasites and
other germfare. Have a great trip!  Stay safe, enjoy your vacation,
and return home with your "best health" still intact. Personally,
I'll be working all summer, so have one on me!

       As always, first do no harm. If this advice is unclear or
seems to be related to any adverse consequences, consult your doctor
or nutritionist. And, have fun.

       (Jennifer Jensen, MS, RD, CNSD is in private practice. She
       offers a sliding scale payment plan for people living with
       HIV/AIDS. And she welcomes your call at 310.450.5581.)


       ==============================
       AIDS and Partner Relationships
       by  Mike Tyoran, LCSW

       (Last of a two-part series)

       Last month, we discussed the challenges and rewards of
persons living with AIDS (PLWA's) and in a partner relationship. The
indications for individual and conjoint counseling as well as
support groups were identified. Communication between partners was
stressed. Nine suggestions were made for well-partners in their
caregiving roles.

       This month, we explore the nine stages couples experience
when a partner is diagnosed with AIDS. These stages were identified
by R. Dennis Shelby, Ph.D., in his excellent book, If a Partner Has
AIDS (Harrington Press, 1992). These stages are predictable as both
partners deal with various issues for varying lengths of time. There
are many life situations that can powerfully bond a couple, and AIDS
is such a situation. The bond takes the form of "we are in this
together."

       In the Wondering Stage, there is an increasing anxiety that
something may be terribly wrong, as certain symptoms indicating
possible HIV infection are noticed. There is the fear and dread that
one or both partners may be infected and need to be tested for the
HIV antibody. Waiting for the test results, couples feel as if a
bomb were ready to drop. They may be confused about when HIV
infections actually results in the disease state.

       The Confirmation Stage encompasses the initial diagnosis of
AIDS and the emotional upheaval that follows. The actual diagnosis
is a shock and is felt like a slap in the face. Anxiety and fear run
high. Assumptions of longevity and growing old together are dashed
and replaced by uncertainty about the future. Well-partners hide the
depth of their initial despair, saving it for a time when they are
alone. Their overriding concern is to "be there" for the newly
diagnosed partner. Well-partners tend to assume that they, too, are
positive, regardless of prior test results. Some will be re-tested
right away; others will wait.

       The medical status and emotional needs of the newly-diagnosed
partner become central to the relationship and define each partner's
duties and responsibilities to each other. The diagnosis draws
couples together quite intensely as they start to close ranks, deal
with the threat, and vow to "beat this thing."  Some couples may
decide out of need or fear not to share any information about their
situation with friends or family, at least for a time. This decision
further unites them emotionally but also isolates them socially.
While couples rally their optimism and resources, there is still a
sense of disbelief in the reality of the diagnosis, wishing it were
only a bad dream.

       The Long Haul Stage covers the period of time between the
decline of the initial shock to the diagnosis and the declining
health of the ill-partner. Well-partners start to accept the gravity
of the situation, and take their caregiving roles quite seriously.
They tend to ignore their own needs as they focus on the needs of
the ill-partner. The goal initially is to sustain the ill-partner
until a cure is found. Later, the goal is to maintain hope in light
of the ever-increasing responsibilities of the caregiving partner
and the worsening medical situation.

       Couples devise a game plan with carefully defined roles to
manage the illness. The caregiving partner becomes the primary
energizer in the relationship and can staunchly enforce the game
plan with a desperate, if not obsessional, quality. The plan
includes rules about eating, vitamins, health food, exercise,
medication compliance, and prohibitions against drinking, drugs, and
smoking, for example.  The plan reassures ill-partners that someone
who loves them dearly will be there to care for them. The plan gives
caregiving partners a desperately needed map to follow during
periods of uncertainty, and reassures them that they are doing
everything possible to help.

       The ill-partner may experience long periods of relatively
good health, followed by periods of acute illness. Holidays and
vacations are greatly appreciated, but at the same time, a certain
sadness and sense of foreboding periodically surface.

       Recurring medical problems result in discouragement. Family
and friends eventually will need to be informed of the diagnosis,
and those relationships will need to be re-negotiated. The partner
relationship itself deepens with the resolution of each medical
crisis. However, there are periods of derailment in which couples
are not prepared for the next medical emergency. It becomes
increasingly difficult to maintain hope.

       The Fever Pitch Stage  encompasses the experiences of the
caregiving partner during the last weeks or days of the
ill-partner's life. Usually by this time, the ill-partner is gravely
ill and communication is substantially reduced. Simply holding
hands, hugging, reminiscing about the past, and just being with each
other take on major importance. An increasing sense of aloneness and
fear comes to dominate the thinking of the caregiving partner who
somehow continues to meet life's daily tasks as well as the needs of
the ill-partner. Juggling these tasks is particularly difficult for
the caregiving partner who continues to work. While work may be a
safe refuge for a time, panic is only a phone call away.

       This stage is a period of sharp emotional contrasts of hope
and despair and. at times, almost frenzied activity. Anxiety often
runs high and sadness begins to mount. Exhaustion, followed by a
sense of detachment, results. It is as if the life of the caregiving
partner is also coming to and end.

       The Calm and Peace Stage starts as the death of the
ill-partner approaches. The caregiving partner often has a
considerable number of tasks to attend to, such as whom to contact
and making arrangements. Yet, despite the activity, the caregiving
partner feels a sense of calm and, perhaps for the first time in
many months, a sense of peace. There is a feeling that a long,
arduous journey is finally coming to an end. Often both partners are
surrounded by family and friends for comfort and support. For the
first time in a long time, as death occurs, the surviving partner is
alone. While the first five stages are determined by the course of
the disease, the last four stages are aftermaths. These stages are
quite fluid in their boundaries and include the mourning process.
Over a period of time, memories of the deceased partner and a
profound sense of loss come to occupy a less central position in the
life of the surviving partner. Family, friends, and, for some
surviving partners, the AIDS Memorial Quilt facilitate the healing
process. The presence or absence of HIV infection can also have a
powerful impact on the process.

       The Chaos Stage is characterized by the first real experience
of aloneness and an intense, sometimes all-pervasive longing for the
deceased partner. The world at times seems unreal. Time is distorted
and the surviving partner feels horribly insecure.

       The Retreat Stage  is marked by withdrawal from a world which
no longer feels safe or meaningful. The surviving partner withdraws
into an intense, almost all-consuming dialogue with the deceased
partner. Yet, while surviving partners want desperately to hold on
to the past, they also feel somehow compelled to move on with their
lives.

       The Exploration Stage is a time of transformation. Surviving
partners begin to try out life again on their own. There is a
gradual waning of intense thinking about the lost partner and the
relationship. They start to feel more self-confident and hopeful for
the future. The thought of dating periodically surfaces. If they
have not already done so, surviving partners are HIV-tested for
their own future plans.

       Finally, the Back into the World Stage is an on-going,
evolving process. There is an emerging excitement at once again
feeling whole and sensing a future with unfolding possibilities.
Surviving partners develop new career goals and new interests. They
become increasingly aware of their emotional and physical needs.
They start to find new love attachments or decide to pass on
relationships for the time being.

       Surviving partners are a tribute to the indomitable nature of
the human spirit. They are the true heroes. They are shining
examples of love and courage.

       =====================================
       Integrase: The Third Enzymatic Target

       HIV causes its "host" cell to make three enzymes that are
necessary for infection and replication. These enzymes are reverse
transcriptase, protease and integrase. While the reverse
transcriptase and protease activities have been extensively studied,
the process of integration is less well understood. Once HIV's
genetic material is transcribed into DNA by reverse transcriptase,
the DNA is inserted into the host cell's DNA by the process called
integration. HIV integrase is absolutely necessary for viral
infectivity and replication; it is responsible for  cutting the host
DNA and splicing the HIV DNA into the host cell's genetic material.
Only after this insertion or integration process is complete can new
HIV proteins be manufactured and assembled into daughter viruses.

       Blocking integrase is widely considered a viable target for
potential anti-HIV drugs. Genetically altered HIV that lacks the
integrase gene is incapable of infecting and killing cells. As
integrase is responsible for carrying out several distinct enzymatic
steps involved in DNA integration, blocking any one of these steps
would likely interfere with DNA integration and, as a result, HIV
infection. Since recent studies indicate that infected cells turn
over (die) at a rapid rate which is matched by (and eventually
exceeds) the rate of new infection, reducing the rate of infection
could maintain a state of homeostasis that could result in a
stabilized immune defense condition.

       Integrase is also an attractive target because, like reverse
transcriptase, no integrase activity is normally present in human
cells. And this fact could reduce the side effects of integrase
inhibitors used to treat HIV infection. There are, however,
potential problems with an anti-integrase strategy. Integration only
needs to happen once for a cell to become infected. Once a cell is
infected, an integrase inhibitor would not help the infected cell or
reduce its production of new viral particles.

       Integrase inhibitors have only one chance to inhibit the
enzyme and once this opportunity is lost the inhibitor becomes
ineffective for that cell. Another potential pitfall of integrase
inhibitors, which is shared by the present group of protease and
reverse transcriptase inhibitors, is that resistant mutants are
likely to arise. There is no reason to believe that inhibition of
integrase will not force the emergence of "escape mutants" that will
expand and colonize a person's infected cells. It is, however,
possible that in order to escape inhibition, the resistant virus
would have to mutate to such an extent that the resultant mutant
virus would not be wholly viable, allowing the immune system to keep
the infection under control, as some scientists have proposed.

       A recent conference sponsored by the National Institutes of
Health (NIH) focused exclusively on HIV integrase. The meeting, the
first of its kind, brought together a variety of scientists studying
every aspect of the integrase enzyme. Much of the research presented
focused on how the enzyme achieves its vital task, and possible
approaches toward blocking integration of the HIV genome. Scientists
from the NIH reported the three-dimensional structure of the active
site of HIV integrase and thereby provided a framework from which
chemists can design possible integrase inhibitors. Similar studies
of the HIV protease provided the means to rapidly produce several of
the protease inhibitors that are currently in clinical trials at
sites around the world.

       Several companies presented compounds derived from laboratory
integrase assays. Several of the identified compounds have high
activity and exhibit encouraging in vitro anti-HIV activity. At the
present time, however, these compounds can only be considered test
compounds and not true drugs, given their toxicological and
absorption profiles. These compounds, however, could rapidly be
turned into viable pharmacologic entities by chemical alterations
and modeling-and such studies are under way.

       One of the most encouraging aspects of the meeting was the
wide interest that pharmaceutical companies and scientists have
demonstrated in exploring the HIV integrase enzyme as a possible
therapeutic target. Most of the large companies-and a sizable number
of smaller bio-tech and mid-size firms-were represented at the
meeting. It is plausible that the successful control of HIV
infection may arise from the combination of several,
less-than-optimal drugs that have different modes of action. As
integrase represents the third and final HIV "native" enzyme,
exploring it as a therapeutic target should be-and has become-a
major research priority. (Adapted from the April 1995 TAGline. For
subscription information, write: Treatment Action Group, 200 East
10th Street, New York, NY 10003.)

       =================================================
       Novedades en El Tratamiento del Sarcoma de Kaposi
       Por Steven Miles, M.D

       Escrito  por Jim Stoecker, Traduccin y adaptacin: Rubn
Gamundi La incidencia de diferentes tipos de cnceres en personas
con SIDA est aumentando. En un estudio llamado ACTG 019, el 27% de
los participantes desarroll algn tipo de cncer durante los tres
aos que dur dicho estudio. El estudio Concord, por su parte,
report que un 26% de los participantes desarrollaron cncer.
Tambin se vio una incidencia de cncer del 23% en participantes del
estudio de profilaxis para MAC llamado ACTG 196.

       La razn por la cual el cncer se est transformando en un
problema en personas con SIDA no es por los qumicos ni por el AZT
que dichas personas usan.  Este fenmeno sucede debido a que las
personas con SIDA no tienen un sistema inmune intacto. La mayora de
los cnceres son exacerbados por la presencia del VIH y como el
sistema inmune no funciona bien, es muy difcil que el organismo los
combata. Hoy en da se ve mas cncer en pacientes con SIDA debido al
hecho de que las personas con SIDA viven mas que antes y eso las
hace mas propensas a desarrollar algn tipo de enfermedad maligna.
El Sarcoma de Kaposi (KS) es todava el cncer que se ve con mas
frecuencia en personas VIH positiva. Es hoy un mayor problema que en
el pasado debido a que las personas viven mas tiempo y tienen por lo
tanto mayores posibilidades de desarrollar cnceres como ya hemos
dicho mas arriba. Debemos tener en cuenta que hoy en da, las
personas con KS viven mas tiempo que las personas que lo padecan
diez aos atrs. Se calcula que hay una disminucin del 62% en el
nmero de muertes por KS comparado con lo que pasaba en los
comienzos de la dcada de los '80. La sobrevida de los pacientes con
KS ha mejorado mucho desde 1985.

       No hay que ser pesimista cuando se trata de KS. Hoy, tenemos
un mejor entendimiento de la forma en que el KS se forma y
desarrolla. Este entendimiento nos ha llevado a tener mas y mejores
opciones de tratamiento. Con suerte, dentro de poco quizs podamos
tener disponible alguna forma de profilaxis para aquellas personas
que estn a riesgo de contraerlo. Como se desarrolla el KS

       En la UCLA (Universidad de California, Los Angeles) hemos
desarrollado un modelo de como se desarrolla y disemina el KS.
Nosotros creemos que en un estadio inicial, algunas clulas son, de
alguna manera, transformadas. Esta transformacin cambia la forma en
que las clulas responden a las citoquinas (protenas producidas por
el sistema inmune) y al tat (una de las protenas del VIH). Dichas
citoquinas y el tat, actan como un agente de crecimiento en clulas
con KS. Para que esto suceda debe existir inmunodepresin.

       El concepto de transformacin celular es controversial.
Barbara Ensolu, quien trabaja en el laboratorio de Robert Gallo,
postula un modelo diferente al nuestro. Ella sostiene que clulas
normales son expuestas a citoquinas y como consecuencia de dicha
exposicin, se transforman. Dicho cambio hace que las clulas puedan
responder al tat y una vez que tat se une a las clulas, acta como
un factor de crecimiento para clulas KS. Debe notarse que en ambos
modelos, las citoquinas y el tat viral son necesarios para el
desarrollo de KS. A diferencia que otros cnceres, KS no puede
crecer por si solo. Esto es importante cuando se consideran opciones
de tratamiento.

       -------------------
       El papel de la IL-6

       La Interleuquina 6 (IL-6) es una protena fabricada por
clulas y que se ha identificado como un factor de crecimiento para
KS. Se ha visto en el tubo de ensayo que si se inhibe IL-6, tambin
se puede inhibir el crecimiento de clulas KS.

       Investigadores han observado los niveles de IL-6 en la sangre
de los hombres que participaron el estudio MACS (Multicenter AIDS
Cohort Study) (Estudio SIDA Multicntrico). Ellos encontraron que la
sangre de hombres VIH positivos tena niveles mas altos de IL-6 que
la sangre de VIH negativos. Tambin se vio que los niveles de IL-6
eran mayores en aquellos con KS.

       Los investigadores tambin hicieron un estudio retrospectivo
de las sangre almacenada y encontraron que los niveles de IL-6 fue
mayor justo antes de que dichos individuos desarrollaran KS. Este
descubrimiento sera importante para detectar quienes son las
personas VIH positivas que estn a riesgo de desarrollar KS.

       ----------------------------------
       Descubrimiento del Herpes Virus KS

       Por largo tiempo se crey que algn tipo de virus de la
familia Herpes tendra lago que ver en el desarrollo de KS. Algunos
investigadores han demostrado una fuerte asociacin entre el
desarrollo de KS y CMV (Citomegalovirus). Data de un estudio de San
Francisco muestra que a medida que la incidencia de CMV ha
disminuido, tambin lo ha hecho la incidencia de KS. Tambin se ha
visto que pacientes VIH negativos con transplante de corazn y/o
rin y que han sido expuestos a CMV, tienen mas posibilidades de
desarrollar KS despus de la ciruga, cuando el sistema inmune est
deprimido.

       Actualmente, investigadores han descubierto el virus Herpes
KS, al que se llamar HHV8 (Virus Herpes Humano 8). Hasta hoy nadie
ha podido aislar al mismo pero se ha podido localizar el gen TK.
Dicho gen activa al acyclovir y a otras drogas similares lo que es
una esperanza prometedora en el tratamiento futuro de KS.

       Recientemente un grupo de investigadores de la Universidad de
Columbia han detectado la presencia de secuencias genticas del
virus KS en 27 de 39 biopsias de individuos con KS, de los cuales
algunos eran VIH positivos y otros no. Es importante recalcar que
dichas secuencias fueron encontradas en clulas KS y no en la
sangre. Esto indicara el porque no se ve KS en aquellas personas
infectadas con VIH va sangre-sangre pero si se encuentra en hombres
a riesgo yVIH negativos. Por lo tanto el herpes virus KS es un
agente de transmisin sexual.

       El descubrimiento dicho virus es muy importante. Ya que nos
permite mejor comprender la enfermedad y poder as encontrar mejores
tratamientos y probablemente alguna forma de prevenirlo en aquellos
que estn a riesgo. Una cosa que todo paciente con KS debe tener en
cuenta es que: "la observacin de las lesiones no es un tratamiento
apropiado". Si usted tiene KS y va a un mdico que le dice: "por
ahora vamos a observar las lesiones y ver como progresan", yo le
sugerira que deje de ver a ese doctor. Con todas las opciones de
tratamiento no hay ninguna razn para que alguien no haga algo al
respecto.

       Hay varias formas disponibles de tratamiento. Una de ellas,
es modular a las citoquinas que provocan que el KS crezca. Tambin
se pueden usar inhibidores del tat. Tambin hay tratamientos tpicos
(en la lesin) y sistmicos (en todo el organismo) al igual que
agentes quimoteraputicos. Inhibidores del Tat

       En UCLA y Boston, 23 pacientes con SIDA estn siendo tratados
con altas dosis de inhibidores del tat (desarrollado por Roche). Los
resultados no fueron muy buenos. No se vio ningn efecto en las
clulas T4 ni en el antgeno P24 y adems se vieron problemas a
nivel del sistema nervioso centra.

       Significa esto que los inhibidores de tat no deberan
investigarse mas? NO, ya que la droga desarrollada por Roche no es
un verdadero inhibidor del tat. Esta droga se acopla con una
protena que interacta con el tat. Yo creo que cuando tengamos un
verdadero inhibidor de tat, encontraremos a un efectivo inhibidor
del VIH y del KS.

       --------------------------------------
       Estudios con Moduladores de Citoquinas

       Una de las cosas que se est estudiando es inhibir al Tumor
Necrosis Factor (TNF), una de las citoquinas que incitara el
crecimiento de KS. La UCLA est preparando un estudio en fase II con
receptores solubles de TNF, los que seran administrados dos veces a
la semana. Los 40 participantes van a recibir la droga. Al menos 50
% de los pacientes deben tener 200 clulas t4 o mas. Los receptores
solubles de TNF harn que no haya TNF circulante. De esta manera
sabremos que tan importante es el papel que TNF desempea en el
desarrollo de KS.

       Otro estudio, analiza Vesnarosine, una droga que tiene efecto
modulador de citoquinas en el tubo de ensayo. Veintiocho pacientes
van a ser enrolados en este estudio que durar 16 semanas. Los
pacientes recibirn vesnarosine en forma oral. El estudio se
alargar en aquellos pacientes que permanezcan estables o que
muestren algn tipo de mejora. Se aceptan participantes en todos
los niveles de KS y con cualquier conteo de clulas T4. No puede
estar usando antivirales.

       --------------------------------
       Nuevos Agentes Quimoteraputicos

       El gran adelanto ha sido el descubrimiento de agentes
liposomales, drogas que hacen "blanco" mas efectivamente en las
clulas KS. Las dos drogas que estn disponibles son doxorubicin y
daunorubicin. La dos son efectivas pero se ha visto que doxorubicin
(DOX-SL) tiene mas actividad y menos efectos indeseables sobre la
mdula sea.

       Estas drogas pueden causar neutropenia severa (disminucin de
las clulas de la sangre) lo que puede ser corregido con GCSF. En
estudios recientes se ha visto una respuesta parcial en el 70% de
los pacientes y una respuesta total en el 7 a 9% de los mismos. Se
cree que doxorubicin ser aprobado rpidamente.

       ----------------------
       Taxol para KS avanzado

       Taxol es una droga que ha sido usada en pequeos estudios en
el Instituto Nacional de Cncer (NCI). Investigadores de NCI
reportan una respuesta favorable en el 55% de los participantes.
Nosotros hemos usado Taxol en UCLA y hemos visto respuestas
dramticas, como por ej. resolucin de edema o hinchazn. Esta droga
tiene sin embargo muchos efectos indeseables y es muy cara.
Actualmente se est diseando un estudio con taxol en UCLA y otro en
USC de taxol en combinacin con bleomycin para pacientes con KS
avanzado.

       -----------------------------------
       Tratamiento temprano con Retinoides

       Los retinoides se aplican en forma tpica (en la lesin). El
mas conocido se llama Retin-A. Hoy en da hay varios en desarrollo.
Estn son drogas muy selectivas y por lo tanto tienen menos
problemas de resistencia e intolerancia. La UCLA y Shared Medical
Research estn conduciendo una serie de estudios en pacientes con
algunas pocas lesiones. Cada persona actuar como su propio grupo
control. Durante las primeras ocho semanas, algunas lesiones sern
tratadas y otras no. Si las lesiones tratadas mejoran, le permitir
utilizar el medicamento en todas ellas.

       En el futuro: Profilaxis contra KS

       Ahora que hemos identificado la causa de KS es posible que
podamos prevenir la enfermedad. Hay varios pasos que necesitamos
para llegar a ello. Primero debemos mejor identificar al Herpes
Virus KS, y as poder desarrollar un test que verifique su
presencia. Esto nos permitir determinar quien estar a riesgo de
contraer KS. Antes de desarrollar KS, aquellos a riesgo podran usar
inhibidores TK que disminuiran las chances de desarrollar KS.
Tambin podramos usar antivirales en contra del HVKS. Debemos
tambin tener un mejor entendimiento del mecanismo de
transformacin. Cuando sepamos todo esto, mejores drogas van a poder
ser formuladas.

       ----------
       Conclusin

       El KS es una enfermedad devastadora. Con todas las opciones
de tratamiento disponibles nadie debera quedarse de brazos cruzados
mirando como las lesiones aumentan. Recuerde que observar las
lesiones no es una opcin de tratamiento. Yo le recomendara a
aquellos con KS que participen de algn ensayo clnico. Para
informacin sobre ensayos clnicos en el rea de Los Angeles llame a
Rubn Gamundi al 213.993.1483. Para informacin acerca de pruebas
experimentales en el resto de los Estados Unidos, llame al
1-800-TRIALS A.

       Trate de encontrar una solucin. Algunos tratamientos puede
que no funcionen para usted. No se de por vencido. Averige sus
opciones y busque tratamiento en una forma agresiva.

       ========================================
       Leucoencefalopatia Multifocal Progresiva
       Por Sarah Huffbauer, MD.

       Traduccin y Adaptacin: Rubn Gamundi

       La Leucoencefalopata multifocal Progresiva (PML) es un
sndrome neurolgico parecido a la Esclerosis Mltiple que se ve en
un 4% de las personas con SIDA que tienen menos de 100 clulas T4. A
pesar de que PML es relativamente raro, un 60% de personas con HIV
experimenta algn tipo de problema neurolgico que debe ser
diferenciado de PML para poder otorgar a dichas personas un
tratamiento adecuado.

       Podemos dividir a los sndrome neurolgicos que ocurren en
pacientes con HIV en tres categoras:

       a) Demencia relacionada al SIDA, que sera causado por el HIV
          mismo.

       b) Neoplasias (cnceres).

       c) Infecciones oportunistas. En orden de frecuencia con que
          se ven  tenemos en este grupo a las siguientes
          infecciones: toxoplasmosis, criptococosis y por otros
          hongos, infecciones causadas por virus como CMV, herpes y
          PML que es causada por un virus de la familia papovavirus
          llamado J.C. (Jacob-Crutchfeld).

       La mayora de los adultos (70-90%) tienen anticuerpos para
este virus y por lo tanto lo que sucede en personas inmunosuprimidas
es una reactivacin del mismo en lugar de una infeccin reciente.

       Este papovavirus fue identificado como la causa de PML en
1958. Dicha enfermedad era muy rara y solo se vea en pacientes con
leucemia o linfoma. En la ltima dcada ha aumentado la incidencia
de PML debido a la epidemia de HIV y por lo tanto se estn haciendo
mas investigaciones sobre el mismo. Como se mencion al principio,
PML, es similar a la Esclerosis Mltiple. Es una enfermedad
desmielinizante del cerebro. Desmielinizante quiere decir que se
destruye la capa de clulas (oligodendrocitos) que recubre y protege
a las fibras nerviosas. La gente con PML con frecuencia muestran
problemas de coordinacin de un miembro o debilidad en el mismo.
Esto tambin se puede ver en la Esclerosis Mltiple (EM).

       Sntomas que solo se ven en PML y no en EM son: dificultad
para hablar o pensar. A estos sntomas a veces le siguen disturbios
visuales, convulsiones, prdida de memoria y dolores de cabeza.
Generalmente PML es muy grave y progresa rpidamente los individuos
que la padecen sobreviven un promedio de 2 a 4 meses despus de que
aparecen sntomas con un rango que va de 2 semanas a 18 meses.

       En los estudios de tomografa computada (CT) y de Resonancia
magntica por imgenes (MRI), se ven lesiones multifocales en el
cerebro. Estas lesiones se ven mejor en el MRI. Se debe hacer
diagnstico diferencial con otras lesiones que pueden ser provocadas
por linfoma o toxoplasmosis.

       Otras formas de diagnstico son puncin lumbar y biopsia
cerebral. Se est desarrollando un nuevo test para el lquido
cefalorraqudeo que tendra una sensitividad de hasta 80%. Este test
y el MRI permitiran hacer un diagnostico de PML sin tener que
recurrir a un procedimiento tan invasivo como la biopsia de cerebro.
Hasta ahora, la biopsia es la nica tcnica que puede dar
diagnstico definitivo. Las biopsias no tienen gran riesgo (solo el
3% tienen complicaciones y se pueden hacer con anestesia local y son
guiadas a travs de una tomografa computada).

       A pesar de que hay tratamiento efectivo para el PML, se han
usado varios antivirales en contra del mismo. Han habido reportes de
que el AZT puede ser muy beneficioso, pero no se sabe con seguridad
ya que un 10% de los casos se resuelven espontneamente. Se est
haciendo un estudio (ACTG243) en el que se compara el mejor
antiviral que la persona puede tolerar solo versus el mejor
antiviral mas un antiviral llamada Ara-C. Dicho antiviral se
administra a travs de inyecciones en el lquido cefalorraqudeo. La
gente que recibe dicho tratamiento debe ser monitoreada de cerca ya
que dicho agente puede provocar varios efectos indeseables.

       A pesar de que nos es muy grato recibir un diagnstico de
PML, cuanto mas sepamos de la enfermedad, mejor la podremos
diferenciar de aquellas patologas que se le parecen y para las que
hay tratamientos efectivos. Se espera que nuevos estudios puedan
llegar a identificar tratamientos efectivos en contra de PML.

       ===============================
       People with PacifiCare - Update
       by Leonard E. Wojtyna

       The efforts of People with PacifiCare (PWPC) culminated in
several new and exciting developments in May. The first to occur was
the inaugural meeting of PacifiCare's new HIV Committee held on May
19 at their offices in Cypress. Electronic message boards throughout
their offices greeted participants with a hearty "Welcome to People
with PacifiCare." More significant was the interest in participation
by PacifiCare employees of various levels and departments. Including
medical group and LifeLink providers and representatives from APLA,
Being Alive, and PWPC, attendance on this committee totaled thirteen
people.

       Of most interest to insured members was the revelation by
Neil Toyota of PacifiCare's Marketing Department of recent
California legislation (SB1832) which prohibits health plans from
releasing any information to employers concerning an employee's
health status or medical treatment. This legislation should ease the
fears of many HIV+  insured members who have called PWPC stating
that they have not used their employer's health plan for HIV
treatment for fear of disclosure of HIV status. For more information
call PWPC at the number listed below.

       Several proposals were raised at this first meeting,
including the development of a Case Management Task Force, part of
whose purpose would be to increase PacifiCare's outreach to HIV+
insured members. Other ideas discussed included conducting an HIV
"Healthcare Economics" seminar for employers, providers and members,
suggestions to conduct symposiums to educate providers regarding
early diagnosis and treatment of HIV disease, and developing a
strategy for obtaining employer support of HIV issues and treatment.
We are also seeking to define our vision for this new committee;
however, we believe our focus should be on global or policy issues
within PacifiCare and its providers that affect the HIV+ insured
member.

       Dr. Mark Katz has agreed to conduct an HMO symposium as part
of his regular monthly Medical Update forum on Monday, September 25,
1995, at Plummer Park. While still in the initial planning stages,
it is expected that this symposium will be directed toward potential
and current HIV+ consumers of HMOs. More information about format
and content will be made available as we approach the target date.

       A representative from Secure Horizons will be attending our
regular June meeting of PWPC in Silverlake. Secure Horizons, a
wholly owned subsidiary of PacifiCare, offers replacement coverage
for Medicare and is generally available for anyone eligible for Part
A and Part B benefits at no additional cost, regardless of HIV
status or prior health care provider. If you are or will be eligible
for Medicare, this is an opportunity for you to hear and ask
questions about how the Secure Horizons plan works and learn the
pros and cons of both alternatives.

       People With PacifiCare (PWPC) meets on the third Saturday of
       each month at the offices of Being Alive, 3626 Sunset Blvd.
       in Los Angeles from 12 to 2 pm. Call 1.800.990.8990 for
       information.

       ===============
       Bits and Pieces
       by Fran McDonald

       All about Public Benefits

       On Tuesday, June 20, at 7 pm at the Being Alive office in
Silverlake there will be a presentation of what's available in
public benefits-Social Security, state disability, food stamps,
MediCal, general relief, as well as information about related
resources such as legal and rental assistance and reduced rates for
utilities and bus passes. If you are contemplating leaving the work
place, this would be a good chance to clear up the mystery that this
subject is to so many people, also to soothe nerves by getting to
know the unknown.

       I'll be there-I hope you will be, too.

       -------------
       Money Matters

       The current issue of Consumer Action News reviews several new
publications that could probably make better the day-to-day lives of
many of our readers. The first, "66 Ways to Save Money," tells how
to stretch your money on car repairs, auto insurance, groceries,
among many others, in advice offered by authorities from consumer,
government, education, and business groups. Single copies are
available for 50 each from: Save Money, Pueblo, CO 81009.

       If you are trying to reorganize your finances to get out of
debt and to avoid filing for bankruptcy, Consumer Federation of
America and Visa USA have put out a brochure, "Managing Your Debts:
How to Regain Financial Health," that can help you turn over a new
leaf financially. For a copy, send a self-addressed, stamped
envelope to: Managing Your Debts, P.O. Box 12099, Washington, D.C.
20005-0999.

       If you have a credit card and want the best deal available,
the Federal Reserve has a new brochure listing over 150 cards with
annual rates from 8.5% to 20.4%. For a copy request the "Credit Card
Brochure" from: Publications Services, Board of Governors of Federal
Reserve System, Mail Stop 127, Washington, D.C. 20551.

       -----------------
       Rental Assistance

       This program, which is different from the renter's credit
that used to appear on the California tax return, gives a
once-a-year rebate to certain individuals who meet the following
criteria:

	1)  lived in a rental unit for which the landlord paid
           property taxes in 1994;

	2)  had monthly rent of at least $50;

	3)  had total household income of $13,200 or less in 1994;

	4)  were 62 or older or blind or disabled on December 31, 1994.

       Depending on a qualifying individual's income, rebates can
range from $240 to $10. I have the application form, so if you'd
like one please call me. And note that the deadline for filing is
August 31, 1995.

       --------------------------
       Check Your Social Security

       Did you know that between 1978 and 1988 almost $70 billion of
wages were not credited to the accounts of almost nine million
workers' Social Security withholding? So concluded a report by the
General Accounting Office prepared as a result of a lawsuit filed by
the National Committee to Preserve Social Security and Medicare.
Since such inaccurate records will result in a smaller monthly
benefit, it's vitally important to keep an eye on your Social
Security account so that should the time come to collect you will
get every cent that you should. This becomes especially important
because Social Security will not correct errors over 39 months old
(not to mention the difficulty of paperwork and the gathering
ofrecords that may be impossible to obtain after such a period of
time).

       Therefore, while you are still working you should request a
Personal Earnings and Benefit Estimate Statement at least every
three years. You can get a request form to fill out so this
information will be supplied by calling Social Security at
800.772.1213. Social Security workers commonly call this form a
"PEBS." And while you're at it, hang onto your paystubs. An empty
shoebox at the back of your closet is the perfect place to put your
stubs as you receive them so that you can prove your point should
the need arise.

       -----------------------
       HMO Consumer Protection

       The most recent issue of The Medicare Advocate has an
informative article about California's new HMO consumer protection
that became effective January 1, 1995, amending the state's Health
and Safety Code and the Insurance Code. Among the changes is one
welcome to anyone who has been denied a particular referral or
procedure. Henceforth, all HMOs must, upon request, reveal to the
Department of Corporations, the HMO's contracting providers, and the
HMO's enrollees the process whereby the HMO decides to authorize or
deny services. Further, the HMO must use criteria developed with
health care providers and that criteria must be reviewed annually.
Changes also affect emergency services and prior authorization of
such services. HMOs cannot require a provider to obtain
authorization prior to rendering emergency services and care;
non-contracting providers must be reimbursed until the patient has
stabilized. From that point onward, if prior authorization is called
for, the new law requires that HMOs have available 24 hours daily a
physician and surgeon to provide such authorization.

       In the matter of complaints, the law now requires the
Department of Corporations to release publicly information about the
HMO complaints it receives, something that was not previously done.
Also new is the requirement that HMOs and insurers cannot release
patient information without the approval of the individual enrollee.

       These are just the highlights of the changes. If you'd like a
copy of the article, please call me.

       (Fran McDonald has been in Social Services for 24 years and
       welcomes your calls at 213. 664.4772.)

       ==========================

       --------------------------------------------------
       State Pays Private Insurance for Medi-Cal Patients

       If you qualify for Medi-Cal and also have private health
insurance, don't cancel your private policy, even if you are having
trouble paying for it. Medi-Cal may pay the premiums.

       Medi-Cal's Health Insurance Premium Payment (HIPP) and
Employer Group Health Plan (EGHP) programs are able to pay private
health insurance premiums for Medi-Cal patients who have high
monthly medical costs. If your monthly medical costs are at least
twice as much as your monthly premiums and if your insurance is not
through another government-subsidized program, then you may qualify
to have Medi-Cal pay your premiums.

       If you think you may qualify or know someone who may, please
       talk to your Medi-Cal eligibility worker or call
       1.800.952.5294 and push 111 to ask about the HIPP and EGHP
       programs.

       ================================================
       Upcoming Activities at Being Alive & Women Alive
       Silverlake
       3626 Sunset Boulevard
       213.667.3262

       Sunday Socials
       Every Sunday
       6:00 - 9:00 pm

       The big weekly event for our community. Lots of fun, food and
good company. All socials are now non-alcoholic.

       The June 25 social will celebrate Gay Pride Day.
       The July 2 social will celebrate the Fourth of July.

       Free Legal Clinic
       By Appointment
       Wednesday, June 21
       7:00 - 9:00 pm

       Get professional advice on legal issues in your life. Call
for an appointment.

       All About Benefits
       Tuesday, June 20
       7:00 - 9:00 pm

       Everything you always wanted to know about: SSI, SSDI,
General Relief and State Disability.

       Brunch for Women with HIV/AIDS
       Sunday, July 9	11:30 - 3:00 pm

       Come meet other women with HIV/AIDS who share your concerns,
fears and hopes in a safe and caring environment. Children are
welcome.

       Massage Therapy
       By Appointment Ongoing

       Invigorating for the body and satisfying to the soul.
Available several days duringthe week. Call for an appointment.

       Yoga

       Starting Tuesday, June 27 & Friday, June 30, 6:00 - 7:00 pm

       Ongoing

       Your instructor, Japa, will guide you through yoga postures,
stretching, breathing techniques and meditations. Wear loose
clothing and bring a mat. Support Groups

       Ongoing

       Twenty different support groups are offered, listed in this
newsletter separately. Drop-ins are welcome.

       HIV Information Library
       Open Monday - Friday
       11:00 am - 6:00 pm

       West Hollywood at The Ron Stone HIV Center 621 San Vicente
       Boulevard (across from Pacific Design Center) 310.358.2281

       Literary Supplements
       Ongoing, First and Third
       Friday of every month
       2:00 - 4:00 pm

       Join us twice a month to discuss and share reactions to
agreed-upon work Conscious Breathing:

       The Healing Power of Your Breath

       Ongoing
       Mondays, 7:00 - 9:00 pm

       Conscious breathing is a powerful way to get in touch with
your body and your emotions. Led by Peter Hulit and others.

       Chiropractic Services by Appointment
       Mondays, 7:30 - 11:30 am
       Back and body adjustments.

       Massage Therapy
       Ongoing

       Convenient for Westsiders. Openings available throughout the
week. Call for an appointment.

       Acupuncture Clinic for Women
       Ongoing
       Thursdays, 1:00 - 4:00 pm

       Let your body benefit from the wisdom of ancient chinese
medicine. Provided by Karen Raub, N.D. L.Ac.

       Women Alive
       4410 Sepulveda Boulevard
       Culver City
       310.313.5139

       That Treatment Stuff
       Ongoing
       Tuesdays, 1:00 - 2:30 pm

       Drop In! Make informed choices about HIV and AIDS treatments.
Become an active partner in your health care.

       Peer Support Group for Women
       Ongoing, Tuesdays,
       6:00 - 8:00 pm

       Here's a support group facilitated by women living with HIV.
Talk to other women who really understand.

       "Old-Timers" Group
       Ongoing, First & Third Friday of every month, 7:00 pm

       A support group specifically for women who have been living and coping with
HIV for several years. A safe and supportive place to discuss issues that
come with being a Long Term Survivor.

       Gay Pride Week-End at the Christopher Street West Festival
       (same location as Being Alive's West Hollywood center)

       Being Alive Booth
       Saturday, June 24
       12:00 pm - 12:00 Am
       Sunday, June 25
       11:00 am - 11:00 pm

       If you volunteer to staff our booth for a four hour shift,
you'll get free admission to the festival.

       Gay Pride March
       Sunday, June 25

       March in the parade with Being Alive's festive contingent.
Call 213.667.3262 for information on gathering time.

       Copyright (c) 1995 - Being Alive.  Noncommercial reproduction
       encouraged.  Distributed by AEGIS, your online gateway to a
       world of people, information, and resources.  714.2486 *
       8N1/Full Duplex * v.34

