AIDS TREATMENT NEWS Issue #250, July 5, 1996
   phone 800/TREAT-1-2, or 415/255-0588


CONTENTS:

Cryptosporidiosis: NTZ at Buyers' Club; Customs Holds
Second Shipment

NAC: First Controlled Trial, Positive Results

Nevirapine Approved

Vancouver Conference: Each Day Summarized Nightly on
World Wide Web

SCIENCE Publishes Major AIDS Issue June 28; Full Text on Web

CMV Retinitis and Treatment: CME Course on World Wide Web

Delavirdine Expanded Access Program Information on
World Wide Web

West Hollywood: AIDS and Chinese Medicine Conference,
July 25-28

Neuropathy: Nutrient Therapies

World Wide Web: AIDS TREATMENT NEWS Lists Over 100 Sites


***** Cryptosporidiosis: NTZ Available at Buyers' Club; 
Customs Holds 2nd Shipment

NTZ (nitazoxanide), an experimental drug which may be the 
first effective treatment against cryptosporidiosis (which 
causes severe diarrhea in persons with AIDS) was recently 
approved in Mexico, and for the first time is now available 
at a U.S. AIDS buyers' club, the PWA Health Group in New 
York. An officially approved compassionate access program 
recently was expanded from 100 to 150 slots. But for weeks 
many people who desperately needed this drug found it 
impossible to obtain, no matter how well connected they were. 
The PWA Health Group recently called people on its long list 
to buy NTZ, and found that half of them had died.

NTZ is inexpensive to manufacture, and is being studied for 
treating many parasites in developing countries. In the U.S., 
it is in phase I trials for cryptosporidiosis.

On June 21 a U.S. Customs office seized half of the PWA 
Health Group shipment of NTZ. Because such cases happen 
frequently and are usually resolved fairly rapidly, the PWA 
Health Group suggests that people contact them concerning how 
they might help if necessary. The shipment may have already 
been released by the time you receive this newsletter.

Meanwhile the PWA Health Group has enough NTZ to treat about 
50 people. They require a doctor's prescription for this 
drug. To obtain a fact sheet on NTZ, to order the drug, or to 
offer to help politically if necessary, contact the PWA 
Health Group at 212/255-0520.


***** NAC: First Controlled Trial, Positive Results

by John S. James

NAC (N-acetylcysteine), a low-cost potential treatment 
approved for certain non-HIV medical uses, has for years been 
one of the most popular "alternative" treatments sold by the 
AIDS buyers' clubs in the U.S. For many years researchers 
have had well-designed research protocols ready to go to 
scientifically test whether NAC can be helpful in HIV 
infection, but finding the funds for this work has been 
extraordinarily difficult. The first controlled trial started 
in late 1993 at Stanford University; now its results have 
been publicly reported at the May 21-24, 1996 meeting 
OXIDATIVE STRESS AND REDOX REGULATION: CELLULAR SIGNALING, 
AIDS, CANCER, AND OTHER DISEASES, at the Institut Pasteur in 
Paris.(1)

Although the design of this study was too limited to tell 
definitively if NAC improves patient survival, it did show 
that the condition NAC is intended to correct (low 
glutathione levels in blood cells) strongly predicts poor 
survival. NAC was found to increase glutathione levels, and 
possibly to improve survival. (Glutathione is an antioxidant 
found in all cells, and is the primary intracellular defense 
against oxidative stress. It is critical for energy 
metabolism, cell division, and other functions, and is 
essential for the life of the cell. Glutathione is a small 
peptide, consisting of three amino acids; NAC supplies 
cysteine, which is the limiting amino acid for the production 
of glutathione. In addition to the need to maintain 
glutathione levels to prevent oxidative damage, it is 
possible that low glutathione levels may accelerate HIV 
replication.)

History

NAC has been controversial in the U.S. medical community, 
because several years ago a small study conducted at the U.S. 
National Institutes of Health reported that NAC was not found 
in the blood when taken orally. Other scientists replied that 
the NAC was well known to be absorbed but was quickly changed 
by the liver into other chemicals which did not show up in 
the tests which were used in that study. But the case against 
NAC being absorbed in useful amounts is the only one that got 
widespread attention.

(Several years ago, this writer asked the lead researcher on 
the NIH NAC study how he would answer the argument that the 
test he used could not usefully determine bioavailability, as 
the NAC would be changed into related chemicals which that 
test would not measure. He told us that his trial was the 
kind required by the FDA for a pharmacokinetic study -- and 
that in addition his results were consistent with other 
reports in the literature. We did not think that this defense 
addressed the issue. At about that time, we were in a room 
with hundreds of AIDS physicians and research assistants 
where the NIH trial results were presented. Those doctors 
walked out of that room convinced that NAC was not absorbed 
and therefore useless. We would have thought the same thing 
too, if we had not talked to the parties involved. This is 
why most of the U.S. AIDS medical community today is 
convinced that NAC is not absorbed and therefore 
ineffective.)

The Stanford Trial

Now there is new data. The recent NAC trial was done at 
Stanford's Herzenberg Laboratory, one of the world's leading 
research groups on flow cytometry, the technology which is 
widely used to measure CD4 and CD8 counts, and which can also 
count many other kinds of cells. Flow cytometry works by 
treating cells so that different kinds will glow differently 
when exposed to a particular wavelength of light (which is 
usually provided by a laser). The cells move individually 
past the laser beam, and the fluorescence (glowing) of each 
is measured by a sensor and counted by computer. This 
technology allows cells to be divided into different 
populations based on many different characteristics. And by 
chemically reacting glutathione so that it will fluoresce, 
this method is also able to measure the glutathione level 
within each cell while simultaneously detecting if it is a 
CD4 cell, a CD8 cell, or some other cell type. As explained 
above, glutathione is a vital antioxidant in the cell -- and 
low intracellular glutathione is the condition which NAC is 
proposed to correct.

The Stanford study collected baseline data on over 200 HIV-
positive volunteers; 83 of them were enrolled in a double-
blind placebo-controlled trial designed primarily to test 
whether HIV-infected people can absorb NAC (since the earlier 
NIH study had raised doubts). Since all but two deaths 
occurred in those who entered the study with a CD4 count 
under 200, further survival analysis was limited to this 
group. Two to three years later (depending on how soon people 
enrolled in the trial), the researchers surveyed all subjects 
who contributed baseline data, to see who had survived. Some 
of the details of the study are complex, but basically the 
findings were:

(1) Low glutathione levels in CD4 T-cells mean increased risk 
of death. This analysis was done in those volunteers who for 
any reason did NOT take NAC in the study (so the researchers 
could see the natural-history association of mortality with 
glutathione levels, in the absence of treatment to restore 
those levels). Statistical analysis showed that those with 
glutathione levels equal to the group mean (0.98) had a two- 
to three-year survival rate of 65%. But of those with 
glutathione levels of 0.6, only 25% survived. The group mean 
itself was below normal, as glutathione levels are lower than 
normal in people with AIDS, as with many other serious 
illnesses. 

(2) Oral use of NAC increases glutathione levels in blood 
cells. A comparison of the 27 subjects who received NAC and 
for whom data was available, vs. the 26 who received placebo 
for the 8 weeks of the formal trial, showed that those on 
placebo had essentially no change; but in those who took NAC, 
glutathione levels went up about two thirds of the way to 
normal. (While the amount of change was only 10-12%, it could 
be meaningful since glutathione levels are fairly tightly 
regulated by the body, and normally cannot change very much.)

(3) This study found that NAC was safe; there were no adverse 
effects attributed to the drug. (There have been other 
reports of gastrointestinal distress at high doses.)

(4) Taking NAC was associated with increased survival -- 
although causality could not be proved by this study. In this 
trial, a direct survival comparison between those assigned to 
take NAC vs. those assigned to placebo was not meaningful, 
for two reasons. First, volunteers in both groups were 
offered open-label NAC for six months after the 8-week formal 
study was completed -- and most accepted the offer. This 
means that most of those assigned to "placebo" really took 
almost as much NAC as those assigned to the NAC group. Since 
this trial was not designed to test survival, there was no 
one who received placebo for the whole time.

So the researchers looked at other comparisons -- which made 
the interpretation of the data more difficult and more 
uncertain. They found that on the average, the group that 
took NAC (for six to eight months) survived about six to 
eight months longer than the group that didn't take NAC.

However, this was not a comparison between randomized groups, 
because this trial was not designed to allow such a 
comparison; those who took NAC were self-selected, and it is 
possible that these patients were healthier, or took better 
care of themselves in other ways, or had a better prognosis 
for some other unknown reason. This means that from this 
trial there is no way to be sure that using NAC contributed 
to survival.

Therefore the investigators could only state that they see 
the results as consistent with the idea that NAC may improve 
survival. They hope to find funding as soon as possible for a 
proper prospective clinical trial to test this possibility. 

[Note on acetaminophen (Tylenol, etc.): NAC in very large 
doses has long been approved by the FDA for treating 
poisoning caused by acetaminophen overdose. NAC is an 
antidote because overdoses of acetaminophen drastically 
deplete the glutathione in the liver, resulting in severe 
liver damage, and NAC provides the cysteine necessary to 
replenish the glutathione. 

The FDA has warned heavy drinkers that alcohol use can reduce 
levels of glutathione, and acetaminophen can depress these 
levels further, causing risk of liver toxicity. Since HIV 
infection also causes reduced glutathione levels, Leonard 
Herzenberg, Ph.D., and Lenore Herzenberg, Ph.D., both of 
Stanford University Genetics Department and principle 
investigators in the NAC study described above, have long 
been concerned that acetaminophen or other medications which 
reduce glutathione levels might be harmful for persons with 
AIDS or HIV, and that patients and physicians could be 
cautious about using these drugs.

References

1. Herzenberg LA, De Rosa S, and Herzenberg LA. Low 
glutathione (GSH) Levels in CD4 T Cells Predict Poor Survival 
in AIDS; N-Acetylcysteine (NAC) May Improve Survival. 
OXIDATIVE STRESS AND REDOX REGULATION: CELLULAR SIGNALING, 
AIDS, CANCER, AND OTHER DISEASES, Institut Pasteur, Paris, 
May 21-24, 1996.


***** Nevirapine Approved

Nevirapine (Viramune(R)) received accelerated approval by the 
FDA on June 24, for use in adults in combination with other 
antiretrovirals. It is expected to be available in August. It 
is the first drug approved in a new class, the non-nucleoside 
reverse transcriptase inhibitors.

For more information about nevirapine, see our previous 
issue, AIDS TREATMENT NEWS #249, which reported on the recent 
FDA Antiviral Drugs Advisory Committee meeting which 
recommended approval. The actual approval came after our 
issue was published.


***** Vancouver Conference: Each Day Summarized Nightly on 
World Wide Web

Persons not attending the XI International Conference on AIDS 
(Vancouver, July 7-12) can follow the highlights in detail by 
taking a daily one-hour CME (continuing medical education) 
course, written nightly by a team of 22 practicing physicians 
and medical writers, and presented each day on the World Wide 
Web. The material is being produced by Clinical Care Options 
for HIV(SM), and will be presented on two different sites on 
the Web. Anyone throughout the world can get an immediate in-
depth report on the conference through these modules -- which 
will remain available after the Conference.

The two sites are http://www.immunet.org/meded and 
http://www.cmegateway.com; the material will be identical but 
the presentation on the Web will be different. See the 
article about the CMV RETINITIS AND TREATMENT CME course on 
the World Wide Web (below) for more information about the 
different sites.


***** SCIENCE Publishes Major AIDS Issue June 28; Full Text 
on Web

by John S. James

The journal SCIENCE will publish a major AIDS issue on June 
28, and will release the full text that day on its Web site, 
http://www.sciencemag.org. This issue includes six 
journalistic articles, two research reports, three 
scientists' viewpoints (on vaccines, drug treatments, and 
chemokines and receptors), and an editorial. Two thousand 
copies will be distributed at the Vancouver conference.

Of particular note is a new picture of HIV, drawn by a 
leading medical illustrator based on the best current 
information from top scientists throughout the world.

The reporting includes a view of AIDS research based on 
information used by the investment community, and a table 
looking at the most-cited scientists among those who have 
published frequently.

Note to Readers: This issue of AIDS TREATMENT NEWS went to 
press a week early, on June 26, so that we can print copies 
to take to the Vancouver AIDS conference. We did not review 
the SCIENCE coverage, but talked to their AIDS reporter Jon 
Cohen.


***** CMV RETINITIS AND TREATMENT  CME Course on 
World Wide Web

by John S. James

The first AIDS/HIV CME course on the World Wide Web -- and 
one of the first CME courses by computer in any medical field 
-- begins operation on June 24. CMV RETINITIS AND TREATMENT 
offers one hour credit for physicians, nurses, and 
pharmacists; patients, advocates, and others interested can 
also take the course without credit. This module covers not 
only the approved treatments (ganciclovir and foscarnet), but 
also some experimental treatments and delivery systems 
available through clinical trials and other special programs 
to some patients. While the course is available throughout 
the world, it focuses on U.S. treatment approaches.

To prevent the material from becoming dated, this CMV module 
will be available for six months and then discontinued. Other 
AIDS-related CME modules will be online by that time.

This CMV course was written by Charles van der Horst, M.D., 
in a project sponsored jointly by Healthcare Communications 
Group and Medical Education Collaborative, and funded by an 
unrestricted educational grant from Roche Laboratories, Inc. 
The material was peer reviewed by the Clinical Care Options 
for HIV National Advisory Board, a panel of internationally 
recognized experts in HIV treatment.

Presentation on the Internet

The same material has been formatted differently and placed 
on two different Internet World Wide Web sites. Although the 
medical information is identical, there are substantial 
differences in the Web presentation which can affect how the 
end user receives the information. Because AIDS TREATMENT 
NEWS has a business relationship with Immunet, one of the 
organizations which has presented the material on the Web 
(see AIDS TREATMENT NEWS #247), we are uncomfortable judging 
or comparing two sites. But readers should know that the 
Immunet site was designed to work well with many different 
Web browsers and different Internet connections -- and "to 
address the needs and values of three unique communities: the 
medical, AIDS, and Web communities," according to Lisa 
Nelson, the site's graphic designer. The other site, by the 
Medical Education Collaborative, can also be reached through 
a link on the home page of the American Medical Association 
(http://www.ama-assn.org). (Note: the period at the end of 
the sentence is NOT part of this or other World Wide Web 
addresses.)

The Immunet site is at http://www.immunet.org/meded. The 
Medical Education Collaborative site can be reached through 
http://www.cmegateway.com.

Note: During the Vancouver conference, July 7-12, both 
Immunet and Medical Education Collaborative will present the 
same one-hour summary of each day of the conference; see 
separate announcement in this issue of AIDS TREATMENT NEWS.


***** Delavirdine Expanded Access Program Information on 
World Wide Web

On June 25 Pharmacia & Upjohn, Inc. opened an Internet site 
on the World Wide Web for information about the expanded 
access program for its antiretroviral delavirdine (brand name 
Rescriptor(R)); this program started on April 1. The company 
will soon apply to the FDA for marketing approval. 
Delavirdine is in the same class of antiretrovirals as 
nevirapine, which was recently approved.

The address of the delavirdine site is 
http://www.pnuaids.com.

Physicians in the U.S. and Canada who would like to register 
patients for the expanded access program, or others who want 
written information, can call 800/779-0070.


***** West Hollywood: AIDS and Chinese Medicine Conference, 
July 25-28

The 4th HIV/AIDS & Chinese Medicine Conference will be held 
July 25-28 at the Wyndham Bel Age Hotel, West Hollywood, 
California. This is a conference for directors of Chinese 
medicine clinics and professional practitioners of Chinese 
medicine: licensed acupuncturists, medical doctors, nurses, 
and others who provide health care to people with HIV/AIDS.

For more information, call Howard Moffet, L.Ac., AIDS & 
Chinese Medicine Institute, 415/282-4028, fax 415/282-2935.


***** Neuropathy: Nutrient Therapies

by Lark Lands

[Editors note: Lark Lands, Ph.D., a well-known health 
educator and consultant, is the author of POSITIVELY WELL: 
LIVING WITH HIV AS A CHRONIC, MANAGEABLE SURVIVAL DISEASE, an 
800-page book which will be published in late summer 1996. 
Before her current work in HIV treatment, she was employed 
for six years as a scientist for the MITRE Corporation, a 
large think tank near Washington D.C., "conducting research, 
designing experiments, and compiling, assessing, and 
integrating information to provide problem resolutions and 
answers to government questions." When AIDS began, she was 
working in clinical nutrition, and has since educated people 
living with HIV on the importance of nutrition with this 
disease. She uses her professional skills to collect and 
organize HIV treatment information -- including not only drug 
therapies but also nutritional and other approaches often 
overlooked by the medical establishment because they do not 
involve proprietary drugs. She has worked with thousands of 
people with HIV infection to help them develop integrated 
treatment programs.

Dr. Lands also has had lifelong diabetes, and is an expert on 
diabetic neuropathy, which has been much better researched 
than neuropathy caused by HIV. She believes that some (not 
all) kinds of HIV-related neuropathy may be similar to the 
diabetic condition, and may respond to some of the same 
treatments. AIDS TREATMENT NEWS asked Dr. Lands if we could 
interview her on what has been learned about treating 
diabetic neuropathy, and how that might apply to HIV. It 
turned out to be more practical to publish a section of Dr. 
Lands' new book than to conduct a separate interview.

Readers should know that Dr. Lands emphasizes an integrated 
program of HIV disease management -- including antivirals and 
other mainstream medical treatments, nutritional approaches, 
and other kinds of therapy -- rather than using nutrition to 
treat only a specific symptom. Also, her book includes a 
detailed section on different kinds of HIV neuropathies. 
Other sections focus in detail on specific nutrients and 
other therapies, providing much information not included 
here. Unfortunately the book is not yet available. But 
readers should know about potential therapies which, although 
not conclusively proven and not officially approved, are 
supported by research, and have appeared to be helpful for 
many people.

Patients should talk with their physician before using any 
therapy, including nutritional treatments. Even if the 
physician is not familiar with or does not approve of the 
treatment, he or she may know about specific cautions or 
contraindications, due to a patient's medical condition.

The following is a small example of the useful information 
Dr. Lands has compiled. Her book will be an important advance 
in providing practical treatment information for persons with 
HIV disease.

[Note: POSITIVELY WELL can be ordered by calling 800/542-8102 
within the U.S. and Canada (from elsewhere, call 905/672-
7470), 9:00 a.m. to 5:00 p.m. Eastern time. The price is 
$24.95 plus shipping and handling. People can leave their 
name, address, phone number, and VISA or MasterCard number, 
which will not be charged until the book is ready to be 
shipped. (Remember that POSITIVELY WELL is not yet available, 
with estimated publication date of late summer. JSJ]

From POSITIVELY WELL: LIVING WITH HIV AS A CHRONIC, 
MANAGEABLE SURVIVAL DISEASE:

Although there has been virtually no research on the use of 
nutrient therapies for HIV-related neuropathies, there has 
been a fair amount of research (mostly in other countries) on 
their use for diabetic neuropathies. Since it appears likely 
that at least some of the mechanisms for the nerve damage may 
be similar in the two diseases (inflammation and oxidative 
damage to the nerves combined with B vitamin deficiencies), 
there is reason to believe that therapies which have proven 
useful for diabetics may also work for at least some people 
living with HIV who develop neuropathy. Many people living 
with HIV have reported to me that they have successfully 
eliminated neuropathy with some combination of the nutrient 
therapies discussed here. Thus, in addition to the other 
treatments mentioned, I would stress the importance of 
therapy with the B vitamins and other nutrients, especially 
acetyl-L-carnitine, gamma-linolenic acid, alpha-lipoic acid, 
magnesium, and chromium. I would definitely consider 
including the nutrients that have been shown to help rebuild 
the myelin sheath around nerves and/or improve nerve 
functioning such as choline, inositol, gamma linolenic acid, 
B6, B12, niacin, thiamine, biotin, folic acid, and magnesium.

Biotin, choline, inositol, and thiamine are B vitamins that 
have all been found useful in treating the peripheral and 
autonomic neuropathies found in diabetes and may also help 
with HIV-related neuropathies. In a study at the University 
of Athens, it was shown that regular, long-term use of biotin 
in diabetics was very effective both for improvement in nerve 
conduction and relief of pain.(1) Improvement in nerve 
conduction occurred after only 4-8 weeks of therapy. In this 
study, biotin was given via daily intramuscular injection (10 
mg/day) for 6 weeks; then 3 times per week (10 mg), 
intramuscularly, for 6 weeks; then 5 mg/day taken orally for 
up to two years. The researchers hypothesize that deficiency, 
inactivity, or unavailability of biotin in diabetics may 
result in disordered activity of the biotin-dependent enzyme, 
pyruvate carboxylase, leading to an accumulation of pyruvate 
and/or a depletion of aspartate, either of which could 
adversely affect nervous system metabolism. There are a 
number of reasons why HIV-positive persons may be deficient 
in biotin and, thus, potentially at risk for a similar 
problem. It has been suggested that those with neuropathy 
symptoms might try 10-15 mg/day orally, taken in conjunction 
with the other B vitamins found useful for improving nerve 
function.

B12 deficiency is a known cause of neuropathy so this 
vitamin, along with its coworker folic acid, should certainly 
be included in any program aimed at eliminating this symptom. 
Typical symptoms of peripheral neuropathy related to B12 
deficiency include the type of leg and foot pains experienced 
by many. B6 deficiencies are also known to cause both carpal 
tunnel syndrome (with symptoms of numbness, tingling, and 
pain in the hands and wrists) and degeneration of peripheral 
nerves and may be responsible for some peripheral neuropathy 
problems.

Choline and inositol also seem to be very important parts of 
the combination of vitamins needed for neuropathy resolution. 
Diabetic neuropathy is known to be associated with a 
reduction in myo-inositol levels in nerves and tissues. The 
decreased level of myo-inositol is believed to cause a 
decrease in the activity of the sodium-potassium pump and, 
thus, to change the sodium permeability of nerves. Both diets 
high in inositol and inositol supplementation have been shown 
to improve diabetic neuropathy. Researchers at the University 
of Alabama found a statistically significant improvement in 
nerve function in diabetics placed on a diet high in 
inositol. Included in the diet were high-inositol foods such 
as cantaloupe, peanuts, grapefruit, and whole grains. Other 
researchers have reported that supplementation with inositol 
in doses of 2-6 grams per day has resulted in improvements in 
neuropathy. Robert Atkins, M.D., has reported his successful 
use of 2-6 grams per day for reversing diabetic neuropathy, 
and notes that physicians at St. James Hospital in Leeds, 
England, have reported good results with even smaller 
dosages.(2)

In addition to the use of inositol itself, treatment with 
acetyl-L-carnitine can help raise nerve myo-inositol content. 
Florida researchers have found that peripheral nerve function 
in diabetes is linked to nerve myo-inositol content and that 
acetyl-l-carnitine can raise the levels of myo-inositol in 
the nerves of animals with experimentally induced 
diabetes.(3) It also apparently protects the nerve membranes 
from free-radical damage, as evidenced by reduced 
malondialdehyde levels in the animals treated with acetyl-l-
carnitine.

Thiamine has also been seen to be useful in treating diabetic 
neuropathy. Stanley Mirski, M.D., has reported that a large 
percentage of his diabetic patients who suffer from 
neuropathy have achieved improvements with daily thiamine 
supplementation in doses of 50-100 mg. Using a fat-soluble 
form of thiamine such as thiamine tetrahydro-furfuryl 
disulfide may be preferable because of the relatively poor 
absorption of water-soluble forms of this vitamin. This type 
is contained in Cardiovascular Research's Allithiamine. A 
large number of HIV-positive people have reported to me their 
successful elimination of neuropathy with the combined use of 
the B vitamins discussed here. The information on acetyl-l-
carnitine is too recent for much in the way of anecdotal 
reports to have surfaced, but it might be an important 
addition to improve the chances for successful elimination of 
neuropathy. Research has made it clear that people living 
with HIV are often deficient in carnitine.

Alpha-lipoic acid has long been used in Europe for the 
treatment of peripheral neuropathy in diabetics. A number of 
controlled clinical trials have shown its usefulness for 
reducing both the pain and numbness suffered by those with 
diabetic neuropathy, and its use for this condition is 
approved in Germany.(4) Its antioxidant properties may help 
protect the nerves from the inflammation and oxidative damage 
that HIV induces, as has been shown to be true with diabetic 
neuropathy.(5) Because of its liver protective and 
antioxidant benefits, it has been included as a component of 
the programs of many of my clients for several years now. It 
may have contributed to the success of the neuropathy 
elimination programs some of them have used.

Gamma linolenic acid is an essential fatty acid found in 
borage oil, grape seed oil, black currant oil, and evening 
primrose oil that has been shown to be successful in 
reversing nerve damage in diabetics suffering from peripheral 
neuropathy. In a double-blind, placebo-controlled study using 
480 mg of GLA daily, all the diabetics given the fatty acid 
experienced gradual reversal of nerve damage and improvement 
in the symptoms related to the peripheral neuropathy, while 
those on placebo gradually worsened.(6) It is thought that 
GLA may help to rebuild the myelin sheath around the nerves, 
thus restoring proper nerve conduction.

Magnesium is also known to be necessary for nerve conduction; 
deficiency is known to cause peripheral neuropathy symptoms. 
Thus, including optimal amounts of magnesium might contribute 
to elimination of neuropathy. There have also been reports of 
chromium deficiency causing peripheral neuropathy. I learned 
this too recently for chromium to have been included in most 
of the neuropathy therapy programs used by my clients in the 
past and, thus, I'm not sure what it might contribute. 
However, chronic infection is known to deplete body stores of 
chromium, so adding a dose of perhaps 200-400 mcg/day to a 
complete nutrient protocol might be reasonable.

In addition to all the nutrient supplements, an analysis of 
data coming out of the Immune Enhancement Program in 
Portland, Oregon, appears to show that their program, which 
includes Chinese herbs along with acupuncture and various 
other therapeutic approaches, results in improvement in 
neuropathy for some. 

For additional information on the nutrients which might be 
helpful for eliminating neuropathy, including appropriate 
dosage ranges, see the individual nutrient entries in Chapter 
Six of POSITIVELY WELL, "Therapeutic Basics." If you are 
considering supplementation with any of the B vitamins 
discussed above, never forget that although B vitamins are by 
and large non-toxic, any individual B vitamin should always 
be taken along with the full B complex to prevent imbalance 
in the body. Long-term use of very high doses of individual B 
vitamins taken alone, without the rest of the B complex, can 
induce imbalances or deficiencies in other B vitamins.

References

1. Koutsikos D, Agroyannis B, and Tzanatos-Exarchou H. Biotin 
for diabetic peripheral neuropathy. BIOMED. PHARMACOTHER. 
Volume 44, number 10, pages 511-514.

2. Atkins R. DR. ATKIN'S NUTRITION BREAKTHROUGH New York: 
William Morrow, 1981, page 194.

3. Lowitt S, Malone JI, Salem AF, and others. METABOLISM. 
1995; volume 44, pages 677-680.

4. Packer L, Wiott EH, and Tritschler HJ. Alpha-lipoic acid 
as a biological antioxidant. FREE RADICAL BIOLOGY & MEDICINE 
1995; volume 19, number 2, pages 227-250.

5. Kehler W, Kuklinski B, Ruhlman C, and Plotz C. Diabetes 
mellitus -- a free radical-associated disease: Effects of 
adjuvant supplementation of antioxidants. In: Gries FA and 
Wessel K (editors), THE ROLE OF ANTIOXIDANTS IN DIABETES 
MELLITUS: OXYGEN RADICALS AND ANTI-OXIDANTS IN DIABETES 
Frankfurt am Main: pmi Verl-Gruppe, 1993:33-53.

6. The Gamma Linolenic Acid Multicentre Trial Group. 
Treatment of diabetic neuropathy with gamma-linolenic acid. 
DIABETES CARE 1993; volume 16, number 1, page 8.


***** World Wide Web: AIDS TREATMENT NEWS Lists Over 100 Sites

by Tadd Tobias and John S. James

As this issue goes to press, AIDS TREATMENT NEWS is opening 
its second Web site, the AIDS TREATMENT NEWS Internet 
Directory (http://www.aidsnews.org). This site will help 
people find AIDS treatment and related information on the 
Internet. Also, it will report news about AIDS-relevant World 
Wide Web sites, and the information they have available.

The list below shows the titles of the sites we are including 
initially, organized by categories. We published it here to 
show readers the variety of information currently available 
on the Internet. We did not include the URLs (Internet 
addresses), because of limited space, and because anybody 
with access to the World Wide Web can visit our site 
(http://www.aidsnews.org) and use the most current version of 
the list to link to any of the sites.

Please let us know about sites we overlooked, and about any 
other ideas for improving this directory.



Treatment Advocates and Information Providers

	* ACT UP / Golden Gate

	* ACT UP/Paris

	* ACT UP/Philadelphia

	* ACT UP/New York

	* AIDS Info BBS Database

	* AIDS Research Information Center

	* AIDS Treatment Data Network

	* Californians for Compassionate Use/
Cannabis Buyers Club

	* CATTY

	* Critical Path AIDS Project

	* Hemophilia Home Page

	* HIVNET/GENA Information Server

	* Joint Project on Legal and Ethical Issues of AIDS/HIV

	* Mothers' Voices Home Page

	* NATAP (National AIDS Treatment Advocacy Project)

	* Outline

	* Project Inform

	* PWA Health Group

	* The Body

	* Treatment Action Group

	* VACTUP

Service Organizations

	* ACSN - AIDS Caregivers Support

	* AIDS Project Los Angeles

	* Gay Mens' Health Crisis

	* KAIROS Support for Caregivers

	* NAMES Project

	* Project Open Hand

Newsletters

	* AIDS TREATMENT NEWS Online

	* Antiviral Agents Bulletin Home

	* CDC AIDS Daily Summary

	* Critical Path Project, AIDS Treatment Publications

	* HIV/AIDS Treatment Information

	* Keep Hope Alive Home Page

	* NAM AIDS Treatment Update

Alternative/Complementary Treatment Information

	* Acupuncture Home Page

	* ALTMED WEB Home Page

	* Bastyr University AIDS Research

	* Critical Path AIDS Project

	* Homeopathy Home Page

	* Immune Enhancement Project

	* Power - Program For Wellness Restoration

	* The Alternative Medicine Homepage

	* World Health Network

	* Yoga for HIV/AIDS

Clinical Trials Information

	* AIDS Clinical Trials Information

	* AIDS Clinical Trials Unit at Washington University

	* Canadian Trials Network

	* CenterWatch Clinical Trials List

	* Clinical Trials offered in Hawaii

	* Critical Path AIDS Project

	* NAM AIDS Treatment Update

	* Trials Search: California HIV Clinical Trials

	* UCLA Care Center

Experts Online to Answer Your Questions

	* AIDS on line!

	* AMA Expert Advice

	* Profnet

	* Vanderbilt Univ. Med. Center HIV/AIDS Online Help

CME (Continuing Medical Education) Online

	* CMV Retinitis & Treatment (an online CME course)

	* Online HIV CME

Conferences and Abstracts, Medical Literature

	* Cambridge Healthtech Institute

	* Establish_Online_Account (MEDLARS)

	* Infectious Diseases Society of America

	* Internet Grateful Med

	* National Library of Medicine - MEDLARS

	* Pharmaceutical Information Network

	* SCIENCE On-Line

	* XI International Conference on AIDS

Medical Sites, Miscellaneous

	* British Columbia Centre for Excellence in HIV and AIDS

	* Glossary of Terms

	* International Association of Physicians in AIDS Care

	* JAMA - HIV Site

	* Medscape

	* OncoLink, The University of Pennsylvania

	* Resources by Disease & Condition

	* Roxane Pain Institute

	* Spinnaker

	* The World-Wide Web Virtual Library

Corporate Sites

	* Immune Network Research Ltd.

	* Pharmacia and Upjohn: Expanded Access ... delavirdine

	* Stadtlanders' HIV & AIDS Focus

	* VSB Corp. (Viatication)

	* Welcome to Isis Pharmaceuticals

Children and AIDS

	* Children with AIDS Project

	* Mothers' Voices Home Page

	* MSSM: Adolescent AIDS Prevention

	* Pediatric AIDS Canada

	* The CANDII Program

Spiritual

	* AIDS National Interfaith Network

	* Belly of the Buddha

	* The HIV/AIDS Ministries Network

Government

	* CDC National AIDS Clearinghouse

	* Food and Drug Administration

	* HyperDOC: U.S. National Library of Medicine

	* National Institute of Allergy and Infectious Diseases

	* National Institutes of Health

	* Social Security Administration

	* Thomas: Legislative Information on the Internet

Unconventional Theories

	* AIDSAuthority (including Duesberg theory)

AIDS Directories on the Web

	* AIDS TREATMENT NEWS Internet Directory

	* Emory University MedWeb: AIDS and HIV

	* Galaxy/EINet AIDS and HIV Resources

	* HIVNET AIDS Resources on the Internet

	* HIV: Electronic Media Information Review

	* JRI Health InfoWeb

	* Links to Other Resources

	* Marty Howard's HIV/AIDS Home Page

	* Medical Matrix-AIDS Information

	* New York Academy of Medicine

	* NOAH: AIDS and HIV Resources

	* Queer Resources Directory (QRD)

	* The World-Wide Web Virtual Library

	* Vanderbilt AIDS Resources

	* Yahoo! - Health:Diseases and Conditions

Web Search Engines

	* Alta Vista

	* Architext Querying

	* Critical Path AIDS Project

	* Deja News Research Service

	* Internet Searching Center

	* Search.com

International Focus

	* AIDS Surveillance in the Americas

	* AVERT HOME PAGE

	* Crusaid HIV Information Exchange

	* Educational Information on HIV for Singapore

	* European Information Center for HIV and AIDS

	* FQD: AIDS/HIV Resources for Filipinos

	* Harvard AIDS Institute

	* HIV/AIDS Statistics in Thailand

	* HIV: Electronic Media Info. Review from Australia

	* Hong Kong AIDS Foundation

	* IRCAM AIDS and HIV - informations and resources

	* World Health Organization



[Note: http://www.aidsnews.org also includes listings of 
sites for technical/specialized research topics, Internet 
free speech, and AIDS sites in French, German, Italian 
Spanish, and other languages. Our resource list for women and 
AIDS was not complete when this issue went to press, but will 
be in the Web site.]


***** AIDS TREATMENT NEWS
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   Internet: aidsnews@aidsnews.org
Editor and Publisher:
   John S. James
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   Denny Smith
   Tadd Tobias

Statement of Purpose:
AIDS TREATMENT NEWS reports on experimental and 
standard treatments, especially those available now. We 
interview physicians, scientists, other health 
professionals, and persons with AIDS or HIV; we also 
collect information from meetings and conferences, 
medical journals, and computer databases. Long-term 
survivors have usually tried many different treatments, 
and found combinations which work for them. AIDS 
Treatment News does not recommend particular 
therapies, but seeks to increase the options available.

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ISSN # 1052-4207 

Copyright 1996 by John S. James.  Permission granted for 
noncommercial reproduction, provided that our address 
and phone number are included if more than short 
quotations are used.

