HIV HERALD
Publication from the National Treatments Project --
Australian Federation of AIDS Organisations
PO Box H274, Australia Square, 
Sydney NSW,  2000 
Australia

Tel : (+612) 231 2111
Fax : (+612) 231 2092


November 1994
Volume 4 No 10

CONTENTS
BITS AND PIECES
>Thalidomide for treating weight loss.
>Cancer drug found to benefit people with AIDS related weight loss.
>Passive Immune Therapy.
>Fusion Toxin News.
>Breakthrough in funding for alternative medicine research in the USA.
>Searle stops further development of it's protease inhibitor.
ANTIVIRAL NEWS
>D4T (Stavudine) interim results released at ICAAC.
>Merke protease inhibitor results reported at ICAAC.
>Side effects of ddC (Zalcitabine, Hivid).
>GEM 91 phase I clinical trial results look good.
OPPORTUNISTIC ILLNESSES
>Clarithromycin as prophylaxis against MAC?
>Why do people with HIV develop an allergic reaction to co-trimoxazole?
GENE THERAPY
>CD8 cells inserted with marker and suicide genes.
COMPLEMENTARY THERAPIES
>Some suggested complementary treatments.



BITS AND PIECES
By Ian McKnight-Smith and Alan Strum

>Thalidomide for Treating Weight Loss.
Tumour Necrosis Factor (TNF) is a cytokine (chemical messenger) of the body that
appears to be involved in the process of weight loss in people with HIV.  Thalidomide
is popping it's head up as a possible treatment to reduce the levels of TNF in people
who are losing weight.  A small study completed in Mexico City showed an average
weight gain of 8% after 12 weeks of treatment, while the placebo group lost an
average of 8% during this time.  A similar study from Thailand showed a weight gain
of 4.5% after 21 days of treatment.  The study in Thailand also had participants (50%)
in it who had tuberculosis, which also increases the production of TNF in people with
HIV.  Neither of the trials measured any markers of the immune system or viral load. 
A trial using thalidomide for weight loss is now starting in the USA.
GMHC Treatment Issues, September 1994.

>Cancer drug found to benefit people 
with AIDS related weight loss.
A drug that was first developed for ovarian cancer also helps people with AIDS to
regain weight, two studies have found.
     Whether the short term weight gains will translate into longer life expectancy
in people with AIDS remains to be shown, according to an editorial accompanying the
studies in the Annals of Internal Medicine (September 15 1994).
     The Food and Drug Administration in the US approved the drug, megestrol
acetate, (Megostat) a year ago for AIDS weight loss based on the two studies that
have now been published.
     First developed as a drug to fight cancer in the breast and ovaries, in part
because of its ability to block the cancer promoting effects of oestrogen, megestrol
acetate also was found to stimulate appetite and weight gain.
     In Professor Von Roenn's study, involving 271 AIDS patients, almost 60% of
those taking megestrol gained at least 2.3 kg in weight compared to 21% of those who
received a placebo
     In the second study, led by researchers from the University of California. People
with AIDS receiving the drug gained an average of more than 5.4kg in 12 weeks, while
those on placebo actually had a further weight loss.
     Both studies found that people taking the drug have a better sense of well-
being than those who were taking the placebo. 
     Dr Donald Kotler (a co-author of the study) said "a popular belief among people
with AIDS is that once the weight loss begins it cannot be reversed and leads to
death." and "weight loss is not a foregone conclusion - weight loss can be reversed."
     Dr. Howard Grossman, a New York City physician who treats many people with
AIDS, said severe weight loss in AIDS could be life threatening. "In most cases it had
to do with a loss of the appetite," Dr Grossman said. Even before the FDA approved
megestrol acetate, he and other doctors who specialise in AIDS had been successfully
using the drug to prevent wasting.  "Megestrol acetate works well. Five pounds (2.3kg)
can make an enormous difference in how well somebody does."
Australian Doctor Weekly   Oct 21 1994
(For more information see HIV Herald August 1994 (vol 4 No 7) p7-8


>Passive Immune Therapy
Passive immune therapy, also known as hyperimmune therapy, is the process where
the fluid of the blood (plasma - which contains antibodies and other chemical
properties) is taken from health asymptomatic people and is given to people with a
declining immune system.  A recent report of a one year study has found that passive
immune therapy is not harmful and may be helpful to people with CD4 cell counts of
between 50 and 200.  The group receiving 500ml of plasma per month showed the
most benefit with less deaths reported than the placebo group, but this was not
considered to be statistically significant.  What was considered to be significant was
the increase in CD4 cells in this group of 32.7 compared to an average  loss of 3.5
cells in the placebo group.  There did not appear to be any differences between the
groups in opportunistic infections, however a French study has reported that there
were 3 times as many AIDS-related illnesses in their placebo group when compared
to the treated group. 
AIDS Treatment News, October 21, 1994

>Fusion Toxin News
A preliminary look at the antiviral effects of DAB389IL-2 fusion toxin were recently
announced. This study enrolled 22 participants with CD4 counts between 300 and 600
cells and who were P24 antigen positive. The participants were randomised to one of
three doses of DAB389; 50,125 and 220 kU/kg/day. The drug was administered
intravenously for 5 consecutive days every 21 days for 3 rounds of treatment. The
volunteers were all off antiretroviral treatment for at least 28 days before starting this
study. 
     Overall CD4 and CD8 counts remained stable during the study and there were
no significant anti-HIV effects detected based on measurement of P24 antigen, viral
cultures, or on viral burden as measured by quantitative PCR (polymerase chain
reaction) test.
     20% of the participants reported side effects such as headaches, nightsweats,
fever/chills and myalgia. There were also a couple of cases of reversible elevated
hepatic transaminase (a liver enzyme). 
Project Inform, Oct 26 1994 

>Breakthrough in Funding for 
Alternative Medicine in the USA.
The National Institute Of Health (NIH) in the USA has given a 3 year grant of
$840,000 to Basyr University in Seattle, WA.  Basyr University was founded by
Naturopaths in 1978 and now offers degrees in naturopathic medicine, acupuncture
and Oriental medicine.  The University has studied potential naturopathic and
alternative therapies to be used for people with HIV for many years.  The grant is to
be used to set up an Alternative Medicine Centre for research into HIV/AIDS and will
be responsible to : -
*    "research the patterns of use of alternative treatments for AIDS and related
conditions.  What is the extent of use of different treatments - both prescribed by
health care providers, and self-administered?  Are people informing their mainstream
doctors about what else they are using?"
*    "screen and evaluate therapies from the field of alternative medicine, including
reporting of adverse events."
*    "train alternative medicine practitioners in the scientific evaluation of their
treatments."
*    "educate the mainstream biomedical community in alternative medical treatment
of HIV infection and AIDS."
AIDS Treatment News, October 21 1994

>Searle Stops Further Development 
of its Protease Inhibitor.
The Searle protease inhibitor candidate, SC-52151, has been withdrawn from further
development after disappointing results from 2 early studies in humans.  Eventhough
the drug works very well at inhibiting HIV in test tubes, the human studies have shown
that the protease inhibitor does not work against HIV in the body.  It is thought that a
human protein binds to the drug once it is in the body, therefore preventing the drug
from being active against HIV.  This is a particular problem that seems to be only
associated with the Searle protease inhibitor, and not with other protease inhibitors
being developed by other pharmaceutical companies.

ANTIVIRAL NEWS

>D4T (Stavudine) Interim Results 
Released at ICAAC
By Alan Strum

D4T, a nucleoside analogue, is currently available through an open access trial in
Australia.  Some of the first interim results have now been released from a phase III
clinical trial, analysing the results of 359 of 822 people with AZT or D4T.  The results
were presented by Bristol-Myers Squibb at the 34th Interscience Conference on
Antimicrobial Agents and Chemotherapy (ICAAC) in Orlando, Florida USA.
     In this trial all people had already been receiving AZT for an average of
approximately 22 months.  Approximately 50% of people in the trial were
asymptomatic, 10% had AIDS and the CD4 cell counts ranged from 50 to 500. 
People in the trial received a single antiretroviral only (monotherapy) in the form of
either D4T (40mg twice a day) or AZT (200mg three times a day).
     The interim results have shown that D4T improves immunological markers in
people who have already been using AZT.  In the group receiving D4T, there were
improvements in CD4 counts, p24 antigen levels and viral load measurements as
taken from human cells (PBMC).  Also, weight gain was seen in the D4T treated group
that was sustained for 80 weeks.  All of the above markers declined in the AZT treated
group of people.  Quality-of-life measurements were significantly higher in the D4T
group than the AZT group.
     The presenter of the report did, however, point out that these results need to
be confirmed by clinical outcomes to see what real effect the D4T is having against
HIV, and whether the improvement seen in the immunological markers will translate
into a delay in HIV disease progression.
     In another session at ICAAC Bristol-Myers Squibb presented information about
a trial with 41 retroviral naive patients (people who had never taken AZT, ddI, ddC or
D4T) and 108 patients who had previously taken AZT for an average of approximately
69 weeks.  When given D4T, the people who had never taken AZT before had a larger
increase in CD4 cells than those who had taken AZT previously.  The information from
this trial was compared with the ACTG116A trial (AZT vs ddI).  This showed that
people who had never taken a nucleoside analogue before and then who took AZT
had an increase in their CD4 cells for approximately 24 weeks, but people who took
D4T as their first nucleoside analogue had an increase in their CD4 cells which
remained above baseline for 48 weeks.
     In general, D4T is showing itself to be a more potent nucleoside analogue than
AZT, but it is still early days, and the only way to really show any differences will be
in the clinical outcomes of these groups of people as they are followed over time.
AIDS Weekly, October 31, 1994

>Merke Protease Inhibitor (L-735,524) 
Results Reported at ICAAC
By Alan Strum

Two phase I clinical trial results were reported at ICAAC involving the monotherapy
use of the Merke protease inhibitor L-735,524.  In all, 16 people participated in the
trials with a median CD4 cell count of 71.  People received a total of 2.4 grams a day
of the drug for 24 weeks.  All participants were p24 antigen positive and had a 2 week
AZT washout period before the trial started.
     Results showed a sustained 90% reduction in p24 antigen, a median body
weight gain from 72kg to 81kg by the 24th week, and a median increase in CD4 cells
of 77.  Two people withdrew from the trial due to drug related toxicity, causing
reversible problems with the liver.  HIV RNA (viral measurements) levels were reduced
by one log for the first 2 weeks, but then rebounded as viral resistance to the drug
occurred.  By the 24th week only 5 of the 14 remaining participants still showed the
virus to be susceptible to the drug.
AIDS Weekly, October 31 1994.

>Side effects of ddC (Zalcitabine, Hivid).
By Ian McKnight-Smith

Last year Roche, the manufacturers of ddC, reported that the drug caused thymic
lymphomas (a form of cancer) in mice when given at very high doses. Furthermore in
one human trial, people who received ddC or a combination of ddC and AZT were
more likely to develop this kind of cancer than were the people who were receiving
AZT alone. However this effect may be just a fluke as there were no cases of
lymphoma reported in the AZT alone group, even though it is an AIDS related Illness.
     Two studies that were reported at the International Conference on AIDS in
Yokohama looked at this issue. The first study confirmed that ddC does indeed cause
cancer in mice. Further the effects seen were directly related to the doses of the drug
given, as well as how long ddC had been given for. In this study the mice developed
lymphomas after 3 months of treatment at the very high dose of 1000 mg/kg/day. They
also developed cancer when they were given a lower dose of 500 mg/kg/day over a
longer period of time (4-6 months), 
     It should be stated however that even in the latter case the dose of 500
mg/kg/day is still an extremely high dose and is about 16,000 times higher than the
average dose  used in humans to treat HIV.
     A further study conducted at the University of Colorado in the United States,
looked to see if the tests that have been conducted in mice are a real guide to what
may be happening when people with HIV take the drug. They reviewed previous
studies that have suggested that mice have a different body metabolism to that seen
in humans, and may therefore convert ddC to a cancer causing substance while
humans do not have the same metabolic process. Another suggestion is that mice are
more  commonly infected with the viruses that cause cancer than is the case in
humans.
     In this study, ddC seemed to cause cancers in mice by suppressing cells from 
which blood cells are derived. As ddC did not seem to suppress these cells in
humans, the researchers suggest that the mouse studies are not a good indicator of
ddC's likely ability to cause cancer in humans.
     A study in San Francisco confirmed that mouth ulcers are indeed more likely
in people who are taking ddC than those taking the other nucleoside analogues such
as ddI or AZT. In the sample 29% of those taking ddC developed mouth ulcers while
only 15% of those taking AZT or ddI.

>GEM 91 Phase I clinical trial results look good.
By Ian McKnight-Smith

At the recent Interscience Conference on Antimicrobial Agents and Chemotherapy
(ICAAC) held in Orlando Florida,  Hybridon announced that they will commence phase
IB/II clinical trials with their antisense compound called GEM 91. (see October issue
of HIV Herald for further information).  The decision to expand research with this
compound has been due to the favourable results of the phase I clinical work which
was reported by Dr Ruiwen Zhang and Robert Diasio from Alabama.
     "This trial conducted at the University of Alabama, demonstrated that GEM 91 
was well tolerated by all patients, which confirms the results of the earlier phase Ia
study." In the phase Ia study a single dose of Gem 91 had been given to 30 HIV
positive people with no clinically significant side effects being reported. "Secondly the
latest study, the trial demonstrated remarkably reproducible pharmacokinetics which
was helpful as we plan for multiple dose trials" said Dr Diasio.
     Also at ICAAC Professor Daniel Sereni reported their Phase Ia study results
that were conducted in France. Sereni reported on the first 24 people treated with
doses of up to 1 mg/kg of Gem 91. In a follow up study, the group have been given
a single dose infusion of Gem 91 at escalating levels up to 2 mg/kg. No clinically
significant intolerance was observed and the blood levels were in the right ranges to
inhibit HIV activity. This study will continue to higher doses. 
     Separately, Drs Groopman and Byrn, have demonstrated that resistance did not
develop in the test tube against Gem 91 over a six month test period, whereas in a
parallel controlled experiment significant resistance developed against AZT. Also, in
another experiment Gem 91 was demonstrated to inhibit HIV isolates that had been
drawn from people with HIV, and were resistant to AZT and ddI. The relative absence
of resistance to Gem 91 may be related to the drugs mechanism of action, which is
a genetic based therapeutic approach.
     So while much of this work is in the test tube or in very early use in people with
HIV, the results look promising.  It will be important to monitor closely the phase II
work with the view of starting trials with this agent in Australia   if and when GEM 91
shows that it is effective against HIV in the body.


OPPORTUNISTIC
ILLNESSES

>CLARITHROMYCIN AS PROPHYLAXIS AGAINST MAC
By Ian McKnight-Smith

The results of a recent study using clarithromycin as a single drug prevention
(prophylaxis) against MAC (mycobacterium avium complex) were presented at the
recent Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC)
held in Orlando Florida. This has sparked a considerable amount of discussion as to
whether this drug should be made available as routine prevention of this illness in
people with CD4 counts below 100.
     The study compared clarithromycin at a dose of 500 mg twice daily to a
placebo control group as  a prophylaxis against MAC. The study had 684 participants
and all had less than 100 CD4 cells. They were randomised to receive either
clarithromycin alone (N=343) or to receive a placebo (n=341).
     Participants who were randomised to receive the clarithromycin had a
significantly lower incidence of  MAC when compared to the placebo group (not really
very surprising really, something being better than nothing). However there were 15
cases of MAC (4.5%) in the treated arm as compared to 42 cases (12.5%) in the
placebo group. 
     There were also significantly fewer deaths in the clarithromycin treated group
N=74 [22%] as compared to 98 [29%] in the placebo group. If we look at the numbers
of side effects reported there were more cases of nausea and taste distortion while
on clarithromycin, while as would be expected, there were higher levels of fever in the
placebo group.
     There was a 68% reduction in the risk of developing MAC on clarithromycin as
compared to placebo, which is clearly a significant benefit and on its own would
indeed suggest that this treatment was effective and should be considered for routine
prophylaxis in this group of people. However 9 of the 15 participants (60%) that
developed MAC while being treated with clarithromycin became resistant to the drug
while all of the participants on the placebo arm who developed MAC remained
sensitive to clarithromycin.
     This means that those 9 participants would receive no benefit if they use
clarithromycin to treat an outbreak of the symptoms of the illness, and there is also a
strong likelihood that those people will also not receive any benefit from azithromycin
as there is nearly always rapid cross resistance between these two closely related
drugs.
     Clarithromycin and azithromycin are major components of the first line treatment
of MAC if and when symptoms of the illness develop. So if indeed the treatment were
to be made available as a routine prophylaxis against MAC, then it is likely that
resistance will develop to both of these drugs in a high proportion of the treated
community and thus this will result in a situation where clinicians will lose two key
treatments for this illness and thereby limit the options that are available to them.
     In contrast however results look far more encouraging with the use of rifabutin
as prophylaxis since it appears to have similar efficacy in terms of preventing the
illness but appears also to have a much lower incidence of resistant isolates
developing. Indeed this drug has been approved by the FDA in the USA, and by
ADEC in Australia, as prophylaxis against MAC. The problem at this time is that we
are still waiting for reimbursement for this product, which is expensive.
     A study comparing clarithromycin versus rifabutin and a combination of the two
drugs is ongoing. It is anticipated that there will be some presentation of progress
results early next year. A combination of the two treatments may make more sense,
since it would be hoped that the treatments would be more effective than if used
alone, and the presence of two treatments would also make the development of MAC
resistance even less likely.


>Why do people with HIV develop an allergic 
reaction to co-trimoxazole?
By Ian McKnight-Smith adapted from an article by Edward King at the
National AIDS Manual in the U.K.

Several suggestions have been put forward as to why people who are HIV positive are
more likely to develop an allergic reaction when using co-trimoxazole
(Bactrim/Septrin/Resprim) than people who have not been exposed to the virus or
even in other people who have unrelated immunodeficiency problems.
     This drug is in fact made up of two separate drugs, trimethoprim (TMP) and
sulphamethoxazole (SMX). It is widely accepted that the drug's allergic side effects are
caused by the SMX component rather than the TMP,
     The reason for using the combination of the two drugs is that they work at
slightly different points in the life cycle of the bacteria and their combined effects are
greater than would be predicted from simply using each of the drugs individually. This
is called a synergistic effect.
     Sulphamethoxazole is much more effective than trimethoprim against the
bacteria that can cause diseases such as PCP (pneumocystis carinii pneumonia). In
the case of other gut, urinary,and respiratory infections TMP alone may be just as
effective but causes less side effects than the co-trimoxazole combination, but TMP
alone has not been tested against PCP alone. In animal studies, TMP alone was
unable to prevent PCP infection whereas the combination of TMP and SMX was
effective.
     The side effects of SMX appear not to be caused by the drug in the form in
which it is swallowed, but by a substance called a metabolite into which SMX is
converted once it is in the blood stream. Inherited (genetic) differences may be one
factor that causes some people to produce this metabolite more effectively than
others, and this may explain why some people are more prone to developing side
effects than others, Indeed, side effects from co-trimoxazole seem to be rarer among
certain racial groups in particular African, Haitian and black Americans with AIDS than
among caucasians. The expression of this inherited difference may also be more
common in HIV positive people with more advanced stages of the illness.
     This theory may explain not only why co-trimoxazole causes side effects, but
also why the side effects are more common in people with HIV. The toxic effects of
the metabolite formed from SMX is usually cleared from the body by an important
immune substance called glutathione. It is well recognised that glutathione levels are
unusually low in people with HIV, and therefore this may then in turn allow an unusual
build up of the toxic metabolite in the blood and hence cause the symptoms of the
side effects.
     It may be possible to increase the levels of glutathione by taking the drug NAC,
A trial to test whether NAC and co-trimoxazole reduces the incidence of side effects
to the latter drug are currently being conducted in Canada.
     Other approaches would be to try to inhibit the production of the metabolite or
to help the body remove it from the circulation more efficiently.
     However, It is probably worth taking some action to minimise the side effects
that are experienced since co-trimoxazole has been proven to be such an effective
treatment and prevention against PCP. It also provides a substantial protection against
toxoplasmosis an illness of the brain and central nervous system.
     It is true that as many as 3 out of 10 people with HIV develop an allergy to co-
trimoxazole. These reactions are characterised by rashes, fevers and a general feeling
that you have 'the flu'. In many cases these effects are so serious that they have to
stop the treatment.  In some cases continued treatment would be life threatening.
     However, a number of centres around the world have developed what is called
desensitisation protocols. That is to say, a method by which they can enable people
to take the drugs that they would otherwise be allergic to. The way this works is to
start by giving people minute doses of co-trimoxazole (see table 1) and then very
slowly increase the doses of the drug so that on the fifth day they are then able to
take the complete dose as is normally found in a standard double dose (DS) tablet.
     The success rate is high with reports of greater than 80% of people being able
to take the normal dose without any side effects. It is also true that if the procedure
is not successful on the first attempt some people will have success on a second or
third round of doses.
     There are some reports that the benefits tend to wear off. In one report where
6 out of 8 people were successfully desensitised to co-trimoxazole, a proportion of
these people had not ended up on the drug for very long. A few months on into
treatment they have developed a 'grumbling skin' reaction or a low grade fever
indicating a continuing but low level allergic reaction. In some of these cases even
further on, they experienced the return of a skin rash. In most cases this will then
mean the cessation of the treatment.
     However many would consider that any period of protection against these
bacterial infections is a worthwhile exercise, and the numbers of people who are able
to remain on longer term treatment after desensitisation is a significant number.

Table I
Co-trimoxazole desensitisation protocol 
As per St. Vincents Hospital Sydney

Dose           Volume         Route of admin: Oral

DAY 1
(use 100 microgram/mL suspension)
10 micrograms  0.1 mL         
20 micrograms  0.2 mL
30 micrograms  0.3 mL
40 micrograms  0.4 mL
60 micrograms  0.6 mL
80 micrograms  0.8 mL
100 micrograms 1.0 mL
200 micrograms 2.0 mL

DAY 2
300 micrograms 3.0 mL
500 micrograms 5.0 mL
600 micrograms 6.0 mL
750 micrograms 7.5 mL
 1 milligram            10.0 mL
 2 milligrams          20.0 mL

(use 10 mg/mL suspension)
   4 milligrams     0.4 mL
   8 milligrams     0.8 mL

DAY 3
 15 milligrams 1.5 mL
 30 milligrams 3.0 mL
 50 milligrams 5.0 mL
100 milligrams          10.0 mL
200 milligrams          20.0 mL
400 milligrams 1/2 a DS tablet
*800 milligrams     1 whole DS tablet

DAY 4
1 double strength tablet taken 4 times per day

DAY 5 
2 double strength tablets taken 4 times per day or according to the persons weight for
treatment of PCP
*If prophylaxis only required omit 800 mg dose on day 3 and commence prophylaxis
dose on day 4.


GENE THERAPY
>CD8 cells coded with a marker and a suicide gene.
By Alan Strum
The Fred Hutchins Cancer Research Centre, in Seattle Washington (USA), released
some preliminary information about a gene therapy trial at the recent ICAAC meeting. 
The trial is enrolling 15 people to have some CD8 cytotoxic cells removed.  Once
removed, the cells are inserted with 2 genes which have a specific purpose.  One
gene will enable the researchers to track where the cells go to within the body when
they are put back in (ie where will the cells go to fight against HIV).  The other gene
is what is being called a "suicide gene".  This suicide gene is a safe guard to ensure
that the cells can be destroyed if they cause an undesired adverse effect to the body
when they are put back in.  The way in which the cells are destroyed is to introduce
a substance to the body which triggers the gene to kill the cell that it is in.  In this case
the substance to trigger the cell death is ganciclovir.  The CD8 cells are also to be
activated against a part of HIV and are to be grown in cell cultures to greatly increase
in cell numbers (propigate).  This way lots of new CD8 cytotoxic cells can be placed
into the body that will hopefully kill or inhibit cells that are infected with HIV.  4
separate infusions with the altered cells are planned for the participants.
     So far 6 people have had their own CD8 cells reintroduced to their bodies with
one person reporting a low grade fever, two people reported muscle pains and night
sweats, and 3 people have had no apparent side effects from their altered CD8 cells.
     Once the trial has been completed, 3 of the 15 trial participants will be given
ganciclovir to see if their altered cells will suicide.  Other areas of development for the
insertion of genes into CD8 cells is introduce genes that will allow the CD8 cells to
function without the need for the presence of CD4 cells.
AIDS Weekly, October 24 1994.

COMPLEMENTARY
THERAPIES

>SOME SUGGESTED COMPLEMENTARY TREATMENTS
By Ian McKnight - Smith

At the recent Positive Living Conference, held in Sydney a session was devoted to the
use of complementary treatments and an interesting paper was given by Peter De
Ruyter, a prominent HIV complementary therapist.
     His discussion suggested that there is much that can be done both in terms of
allopathic (western) medicine and the various disciplines in complementary therapy.
He strongly indicated that neither should be exclusive of the other, and that clinicians
in both schools of therapy should get a better understanding of each others approach.
     He also indicated that there are no "magic bullet" treatments in HIV and that it
is a concerted effort to retain the highest levels of "life force" for the longest periods
of time. To achieve this, his approach is reduce as many of the possible events that
will drain life forces. Some these include, smoking or taking recreational drugs and of
course this includes tobacco, alcohol and marijuana, while others would include late
nights,  stress, poor diet and so on.  He also suggested that the use of some of the
western medicines may be toxic or have side effects and they then in turn will drain
the life force levels.
     However, in his opinion probably one of the most significant and most
overlooked factors is the mental approach to the condition. That is to say the likelihood
that a person with HIV who feels that they will get sick, will indeed get sick. On the
other hand the person who mentally conditions themself to remain well, is far more
likely to do so and for long periods of time.
     There are no quick fix remedies and he suggests that anyone who is
considering the addition of natural or complementary treatments to their own health
care should first consult an appropriate therapist for advice on your individual needs.
     Peter did suggest however there are a number of natural treatments that can
assist and provide "first aid" against a number of conditions. We have included a list
of his suggestions as a guide to some of the conditions often faced by people with HIV
and AIDS.

ANOREXIA (excessive weight loss)
Swedish Bitters 
The dose is between 2-5 ml diluted in water and taken 1/2 an hour before food.
Bitter Herbs such as Gentian and Yarrow

Both of these are available from health food stores

NAUSEA
Ginger
As a tincture or made as a tea from the fresh root; 
1 teaspoon of finely sliced root per cup of boiling water
Swedish Bitters
The dose is the same as for anorexia

NIGHTS SWEATS
Sage Tea
1 teaspoon dried herb per cup of boiling water and allow to stand for several hours.
Dose 1 cup 2-3 times daily.
Homeopathic Reckeweg R32 (available from practitioners or from Newtons Pharmacy
119 York Street Sydney ..Ph 02 267 7889).
Place 10-15 drops under the tongue 3-5 times daily or as needed during the night.

MOUTH ULCERS
Vitamin B5
100-200 mg / day
Zinc
This can be obtained by taking "control acidophilus"
1 capsule three times per day.
Beta carotene
50-100,000 international units per day for several weeks and then decrease the dose.
Acidophilus

FATIGUE
Coenzyme Q10
Up to 4 capsules taken 3 times a day
DMG
2ml taken twice a day.
Spirulina
3 capsules taken 2-3 times per day.
Herbal Tonics such as Bitter Melon tincture

SHINGLES AND HERPES
Homeopathic Reckeweg R68
10-15 drops under the tongue from 3 times daily up to every hour depending on the
severity of the outbreak.(available from practitioners or from Newtons Pharmacy 119
York Street Sydney ..Ph 02 267 7889).
L-lysine
500 mg four times a day taken on an empty stomach.
I.M.I. B12 injection 
1 mg per day (available from your chemist).
Hypericum
2ml taken three times per day (available from practitioners).
Leek juice
apply the juice of the vegetable to the sores to help alleviate the pain.
Cut out all chocolate and nuts since they are high in arginine which feeds the virus.
Lecithin
1-2 gram capsules taken three times per day
Homeopathic "Zincum met.30"
5 drops under the tongue twice a day to minimise the post herpetic neuralgia. This is
available from practitioners.

DIGESTIVE DISORDERS AND MALABSORPTION
Swedish Bitters  This stimulates the gastric/pancreatic and liver secretions
The dose is between 2-5 ml diluted in water and taken 1/2 an hour before food.
Bitter Herbs such as Gentian and Yarrow
Both of these are available from health food stores
Acidophilus 
But have your practitioner check for and treat bowel infections/ecological imbalances.
Beta carotene
20,000 i.u,/day
"Control acidiphilus"
1 capsule taken 3 times per day.

DIARRHOEA
Herbal Composition Powder (Nupro)
3 capsules taken 3 times per day
Acidophilus
Garlic 
Although in some cases this may not be appropriate.
Gastrolyte
Available from most chemists
Hydrochloric acid supplements 
These can be very effective but must always be taken with food!
Homeopathic Reckeweg R4
(available from practitioners or from Newtons Pharmacy 119 York Street Sydney ..Ph
02 267 7889). 10-15 drops 3 times per day or every half an hour if uncontrolled.
Slippery Elm Powder.
1 tablespoon in
     -white rice 1/2 cup
     -1/2 grated apple allowed to go brown
     -acidophilus, 1 teaspoon
     -Probioplex, 1 tablespoon
     -Gastrolyte mixed into to make a porridge.
     -Cinnamon or nutmeg to taste.
This can be eaten as often as desired, and helps supply some
calories/nutrients/electrolytes as well as often settling the diarrhoea.

ORAL HAIRY LEUKOPLAKIA
Beta carotene
100,000 i.u per day + folate  3-5mg per day.
This treatment should be taken under the supervision of your practitioner.
Propolis lozenges
