AIDS TREATMENT UPDATE

Issue 47, November 1996


In this issue:

- Using protease inhibitors
- The cost of treatment
- AIDS tongue-twisters
- Glossary
- Noticeboard

***


USING PROTEASE INHIBITORS

How are British clinics prescribing the recently licensed drugs?

By Edward King

In early October, the European Commission gave the go-ahead for indinavir and saquinavir to be marketed throughout Europe. Like ritonavir, which was approved a few months earlier, they are licensed for the treatment of people with HIV "advanced or progressive immunodeficiency". 

As discussed in the article on page 4, some doctors (especially outside London) say that they are unable to prescribe drugs to everyone whom they think might benefit because of funding shortages. Setting aside this issue for the purposes of this article, AIDS Treatment Update spoke to doctors around the country to discover how they intend to prescribe the new drugs at their clinics.

>>PREVIOUSLY TREATED PEOPLE

One major group of people who can reasonably expect to be offered a protease inhibitor are those with very low CD4 counts, as well as those with higher CD4 counts who are experiencing disease progression despite taking other anti-HIV regimens.

A placebo-controlled trial in people with CD4 counts below 100 found those who added ritonavir to whatever other anti-HIV drugs they were already taking had a significantly reduced risk of disease or death over an average follow-up of six months. Dr Martin Fisher of the Royal Sussex County Hospital in Brighton said that as a result he would offer a protease inhibitor to any patients with a CD4 count below 100, whether or not they seemed to be doing well on current therapy. Dr Mike Youle of the Chelsea and Westminster Hospital agreed that he would discuss protease inhibitor treatment with any patient with a count below 100, and would actively recommend treatment to those with counts below 50.

You may simply be able to add a protease inhibitor to your existing treatment with a combination of nucleoside analogues (AZT, ddI, ddC, 3TC and d4T), if that treatment was started relatively recently and there is no reason to believe that you have developed resistance to any of the drugs. Otherwise, Dr Fisher pointed out that it is important also to adjust the other drugs, to ensure that the protease inhibitor is being added to a combination that is still working. Some doctors go further, arguing that any change of treatment should always involve at least two new drugs to which you have not previously been exposed. So people currently taking AZT plus ddI, for example, may be advised to switch to AZT plus 3TC when adding a protease inhibitor, or even to an entirely new combination such as d4T, 3TC and a protease inhibitor.

Which of the three protease inhibitors should previously treated people use? One option is ritonavir, which was been shown to be effective in the clinical trial mentioned above. However, several clinics are instead recommending indinavir, even though the evidence for its effectiveness is still based solely on its effects on viral load and CD4 count, not on disease progression and survival. 

Professor Jonathan Weber of St Mary's Hospital in London said "There's not much between indinavir and ritonavir in terms of efficacy, but the problem with ritonavir is its side-effects and interactions with other drugs. We've found that about a quarter of patients can't tolerate ritonavir. Indinavir is not without side-effects but it is better tolerated."

Dr Mike Youle agreed that "In my experience indinavir combined with two nucleoside analogues is the fastest way of increasing your T-cell count. Ritonavir is less well-tolerated."

Dr Ray Brettle of City Hospital in Edinburgh, which sees a large number of HIV-positive drug users, said "At our practice, ritonavir is at the bottom of the list of protease inhibitors because we don't know what the interactions are going to be with drugs such as valium and methadone. We've used indinavir more, and that seems to be okay."

Apart from the ritonavir study, the only protease combination to have demonstrated a benefit for AZT-experienced people in terms of symptoms and survival is saquinavir plus ddC. Nevertheless, none of the clinicians we spoke to favoured using saquinavir among AZT-experienced people. "I don't use saquinavir because the benefits I've seen for patients have been less than with indinavir," said Dr Youle. However, he noted that he might make an exception if saquinavir was combined with another protease inhibitor (see box).

>>PREVIOUSLY UNTREATED PEOPLE

Saquinavir was looked at more favourably as an option for people who have not taken anti-HIV drugs before. Using a protease inhibitor as part of an initial treatment regimen is based on the theory that the more you suppress viral load with anti-HIV drugs, the greater the benefits in terms of a delay in disease progression are likely to be. No trials have yet established whether three drugs are really more effective than two for people starting treatment, but this approach is favoured by some doctors who argue that treatment should be based on "biologically plausible" theories, and not just on clinical trial results. 

Looking only at trial data, the best supported treatments for people starting therapy are the Delta combinations of AZT plus ddI or ddC, which have been shown to delay the development of AIDS and prolong life. Trials of AZT plus 3TC have focused more on its effects on CD4 counts and viral load, but there is also good evidence that this combination can also delay disease progression. It's important to  remember that a proportion of people achieve very good anti-viral effects (such as undetectable viral load) from taking a combination of only two anti-HIV drugs, allowing them to hold protease inhibitors in reserve for later.

Some doctors feel that anyone who starts treatment with two drugs but doesn't get an adequate reduction in viral load after a month or two should then consider adding a protease inhibitor. The definition of an 'adequate reduction in viral load' varies; some doctors are happy with a one log (10-fold) reduction or more, while others say that they would recommend adding a third drug for anyone whose viral load had not fallen below the test's lower limit of detection. 

However, even in the absence of reliable clincial trial data, some clinics already suggest that people with CD4 counts around 350 and high viral load should consider using three drugs from the very start. Again, the definition of 'high viral load' varies; some doctors considered it to be above 50,000, while others suggested above 100,000.

A growing number of clinics also recommend very recently infected people to start treatment promptly with a triple combination (see AIDS Treatment Update issue 44, page 3).

"We are putting an increasing number of treatment-naive people on AZT, 3TC and saquinavir," said Professor Weber. The attraction of that combination is that side-effects are relatively uncommon with both 3TC and saquinavir, a particularly important consideration for people who may not have developed any HIV-related symptoms and don't want their quality of life marred by symptoms caused by treatment.

Dr Brian Gazzard of the Chelsea and Westminster Hospital points out that saquinavir's 'resistance profile' is another reason to favour it as early treatment. It appears to take quite a long time for HIV to develop resistance to saquinavir, and even then a high level of resistance is quite uncommon. What's more, it seems to be likely that saquinavir-resistant HIV may still be susceptible to the effects of ritonavir or indinavir. By contrast, HIV that has become resistant to indinavir is definitely also resistant to ritonavir and vice versa, and it may also be resistant to saquinavir and other protease inhibitors yet to come onto the market.

Dr Gazzard also pointed out that for people considering triple combinations, there may soon be other alternatives to using a protease inhibitor. Promising results have been seen from combinations including non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as nevirapine (see AIDS Treatment Update issue 43), which is a licensed drug in the USA but not yet in Europe. Dr Gazzard suggested that the NNRTIs may be most effective if used by people with relatively early HIV infection, and that protease inhibitors could then be reserved as a secondary option for the future.

Just as there is currently little information about the long-term effectiveness of protease inhibitors, so there is not much known about the possible side-effects of long-term use. Dr Brettle noted "To date there seems to be only about a year of toxicity data, so I'm cautious about rushing in to give a protease inhibitor to people who may have to take it for three or four years. That's why I'd usually limit their use to people with quite advanced disease. As more information becomes available, I may become happier about prescribing them for a wider group of patients."

More protease inhibitors are likely to become available soon, such as Agouron's nelfinavir which is already available in an expanded access scheme in the USA. Unless you urgently need new options, you might be well advised to delay a decision until more drugs and more trial results are available.


BOX - Combining two protease inhibitors

There is growing interest in the possible effectiveness of combinations of two protease inhibitors. There's little hard evidence to date, but what does exist relates to the combination of ritonavir and saquinavir.
The appeal of this combination is three-fold:

- in general, as with other combinations, two drugs may be better than one
- in particular, ritonavir reduces the amount of each dose of saquinavir that is removed from the body by the liver, so you can achieve much higher blood levels of saquinavir
- it may provide an effective treatment option for people who are unwilling or unable to take nucleoside analogues such as AZT and ddI, even though there's far more evidence about the safety and effectiveness of nucleosides

An ongoing American trial is testing the combination for people who have taken anti-HIV drugs extensively before. Results from the first twelve weeks were presented at a conference in New Orleans in September. On average, participants experienced about a 3 log reduction in viral load, and a 95 cell increase in their CD4 count.

As reported in last month's issue of AIDS Treatment Update, the Medical Research Council hopes to start a new trial called ProCom early in 1997. Participants with CD4 counts below 350 or viral load above 20,000 will be allocated to one of four arms:

- two-drug combination of saquinavir plus ritonavir
- four drug combination (d4T, ddI, saquinavir and ritonavir)
- four drug combination as above for 12 weeks, then reduced to only two drugs (d4T plus ddI in the third arm, or ritonavir plus saquinavir in the fourth arm)

The trial is designed to test whether it is possible to achieve the maximum possible suppression of viral load with four drugs, and then keep it suppressed over the longer-term using only two drugs, which would hopefully cause fewer side-effects.

Another study is planned at St Mary's Hospital in London, which conducted early studies of saquinavir and so has a group of people who have taken that drug for more than four years. This study will see how well they respond to adding ritonavir to the saquinavir that they are already taking, compared with a group of people with similar CD4 counts and viral load who start the ritonavir and saquinavir combination but have never taken a protease inhibitor before.

Some doctors are already using protease combinations for specific cases in their clinics. At the Chelsea and Westminster Hospital, a number of people who had been taking saquinavir but were experiencing disease progression have added ritonavir. Dr Graeme Moyle told AIDS Treatment Update that in general few seem to have responded well, and several have had to stop due to side-effects. Dr Mike Youle noted that among people with advanced disease who have started on indinavir, about one in five have failed to respond well, and that he is offering the combination of ritonavir and saquinavir as an option for them.

***


THE COST OF TREATMENT

Is the funding crisis preventing doctors from giving the best care?

By Keith Alcorn

As the shortage of AIDS funding continues to bite, there is growing evidence that some people with HIV are being denied powerful new treatments purely on the grounds of cost.

Money for AIDS treatment and care is allocated by the Government to district health authorities, which in turn divide it between the service providers in their area, such as the hospital NHS trusts. However, many NHS trusts are still attempting to meet the costs of the new combinations from HIV drug budgets which were allotted on the basis that a relatively small number of patients would receive treatment with AZT monotherapy at approximately o2,000 per patient per year. But as the costs of drugs grow and the demand for treatment accelerates, all treatment centres face huge financial problems, and last year's 7% cut in the AIDS treatment and care budget has not helped matters.

How much does three-drug combination treatment cost? It is estimated that AZT, 3TC and indinavir costs in the region of o7,000 per patient per year. It is impossible to be more precise about such costs because virtually every NHS trust negotiates an individual price with the manufacturer or wholesaler of a drug. In comparison the combination of AZT and 3TC costs about o4,000 per patient per year.

>>FINDING MORE MONEY

Clinic managers are looking for savings wherever possible. For example, the Chelsea and Westminster Hospital has stopped prescribing a range of drugs and sends patients to get these drugs from their GPs instead. The drugs include the anti-herpes drug acyclovir, sleeping tablets and anti-depressants. This transferred some costs away from the AIDS treatment budget and into GPs' budgets.

However, such a move will not release all the money required to fund the increasing cost of drug therapy in future years. Simon Hall, Commissioner of HIV services for Kensington Chelsea and Westminster, says that unless AIDS treatment funding for London is increased by around 10% next year, cuts will have to be made in voluntary services in order to finance the treatment protocols already agreed with treatment centres. "We are committed to funding evidence-based medicine, and patients will not go without treatment for financial reasons," he said. Health authorities will learn how much funding they can expect next year in the Autumn budget statement on November 26.

Outside London, however, some large treatment centres are already reporting difficulty in funding dual combination therapy, let alone any further innovations in treatment. For instance, Dr Paddy Horner of Bristol Royal Infirmary is not optimistic about the prospects for funding the new treatment regimes at his centre. "Our purchaser agrees with the argument that we should provide triple combination treatment and viral load testing, but says no extra money will be available in this financial year. If no further money is available next year there will have to be a serious debate about spending priorities in this district and others in view of what we've learnt in the past six months," he said.

Dr Horner points out that the AIDS treatment and care budget for Avon Health Authority is L1.3 million, of which L660,000 currently goes to fund all AIDS treatment at Bristol Royal Infirmary. The cost of treating 70 patients a year with triple combination therapy would amount to about L500,000 per year. 

"I've had patients offering to pay for protease inhibitors, and it might have to be considered. I find it incredibly difficult, both personally and professionally, to tell patients that I am unable to offer certain forms of treatment on the grounds of cost. It's also a major concern that it may be prejudicing the patient's future chances if I prescribe two drugs rather than three. We are not even able to offer viral load testing at present."

Dr Horner also argues that under-funding of treatment services now will do lasting damage. "We're supposed to be part of an internal market, so purchasers and the Department of Health will have to accept that some patients will move to centres in London. That will erode the service in Bristol to the long-term detriment of the majority of patients in this district," he said.

Dr Ray Brettle in Edinburgh says that his NHS Trust has insisted that he remains within his budget. "Last year I was overspent, but the Health Board [the Scottish equivalent of a district health authority] agreed to pick up the deficit out of its reserves so my Trust didn't mind. This year the Health Board have said they won't do that. That means that unless I get more money I may have to limit protease inhibitors to people who are dying and may get an extra couple of years from it, rather than offering them to people who are currently fit and well."

>>COST-EFFECTIVENESS

It will also be important for researchers to prove that the new and expensive drug regimes are more cost-effective in the long-term than no treatment. If triple combination therapy defers death by, say, 10 years, is it cheaper for the NHS to spend L70,000 on drug treatment or to bear the cost of a patient developing AIDS much more quickly? 

Evidence is still being gathered concerning the cost-effectiveness of treatment with triple combinations. Data presented in Vancouver suggested that patients with advanced HIV disease who received ritonavir for one year would cost over o1,000 a year less in medical costs, even when the price of ritonavir was taken into account. This saving was calculated by looking at the differing rates of opportunistic infections in the groups of patients who received ritonavir or a placebo, and assessing how much it would cost to treat the two groups.

For example, it is extremely expensive to treat CMV disease, MAI and the other more severe conditions which emerge in advanced stages of AIDS. Treatment which cuts the rate at which people develop these conditions by 50% a year will demonstrate its cost-effectiveness immediately if it is rationed to people with the most advanced disease, but treatment which is available to people in much earlier stages of HIV infection and which does not demonstrate its cost-effectiveness for a number of years will lead to a short-term increase in costs.

Compared with some standard therapies in other medical areas, the cost of a year's extended life due to triple combination therapy is not especially expensive. Various forms of cancer or heart disease treatment cost much more per year of life saved.

>>MAKING YOUR VOICE HEARD

So where does the buck stop? Who can patients complain to if they are being denied treatment on grounds of cost? On the one hand, the Government's NHS reforms have devolved on to district health authorities the responsibility for decisions about which treatments should be funded, but on the other hand the Department of Health controls the overall size of the budget that is distributed among health authorities.

Professor Tony Pinching mentioned that PACT, an organisation drawing together AIDS treatment and care providers, is involved in negotiations with commissioners. "We are willing to go through the proper channels, but those channels have to be responsive to the genuine problems that we're all facing."

However, other observers argue that the Government is unlikely to make special provisions for AIDS, given the shortage of cash which already afflicts the NHS as a whole. "There is considerable sensitivity in the Department of Health over past accusations that AIDS has been over-funded and that the Department has been the prisoner of special interests, especially a vocal gay lobby," said a health authority commissioner who did not wish to be identified. "It is unlikely that the Government will respond positively to a high profile campaign urging them once again to make a special case out of AIDS and bail out health authorities now. The best we can hope for is an increase in AIDS funding in the budget next month. In the short term, if people want to lobby, they are going to have to persuade Directors of Public Health and health authority boards in particular districts that money should be switched from other areas to meet AIDS drug costs. That requires a very organised lobbying effort."

***


AIDS TONGUE-TWISTERS

A guide to pronouncing the names of AIDS drugs and infections

By Brian Cooper

To be able to talk about treatment options, it can help to know how names of drugs and infections are pronounced. Medical terms can appear intimidating, and the ability to pronounce them can go some way to giving you confidence with medical professionals.

This list may help you get your tongue around some difficult drug and infection names. The notation used is based on standard written English, with each syllable separated by a hyphen. These should be read as separate words that merge into one another.

Each word in English has one principal syllable which is stressed when the word is spoken, and this is shown here by enclosing the syllable in asterisks. For instance, in the word London, the first syllable is stressed, whilst in the word Australia, the second syllable carries the stress. Hence London would be written:
	*lun*-den
and Australia would be written:
	oss-*tray*-lee-ah
The pronunciation shown here is either the standard or, where differences exist, an acceptable version. In some cases you will find doctors or pharmacists using different pronunciation.


>>DRUG NAMES

3TC (lamivudine, Epivir)
three-tea-see  lam-*iv*-you-dean  *ep*-pea-veer

Acyclovir (Zovirax)
ay-*sike*-low-veer  *zov*-veer-axe
[ay as in 'hay'] 

Amphotericin B (Fungizone)
am-foe-*tair*-ee-sin bee  fun-jiz-zone

Atovaquone (Wellvone)
a-*toe*-va-kwone  *well*-vone

Azithromycin (Zithromax)
as-*ith*-throw-my-sin  *zith*-throw-max

AZT (Zidovudine, Retrovir)
ay-zed-tea  zide-*of*-you-dean  ret-trow-*veer*
[ay as in 'hay']

Bleomycin
blee-oh-*my*-sin

Cidofovir (Vistide)
*side*-off-a-veer  *vis*-tide

Ciprofloxacin (Cipro)
sip-row-*flocks*-a-sin  *sip*-row

Clarithromycin (Klaricid)
kla-*rith*-row-my-sin  *kla*-riss-sid

Co-trimoxazole (Septrin, Bactrim)
co-trim-*ox*-as-zole  *sep*-trin  *back*-trim

Dapsone (Maloprim)
*dapp*-sown  *mal*-low-prim

ddC (zalcitabine, HIVID)
dee-dee-see  zal-*sit*-tab-bean  *hiv*-id

ddI (didanosine, Videx)
dee-dee-eye  die-*dan*-a-seen  *vye*-decks
[vye as in 'virus']

Delavirdine (Rescriptor)
dell-*lav*-veer-dean  res-*script*-or

Famciclovir (Famvir)
famm-*sike*-low-veer  *famm*-veer

Fluconazole (Diflucan)
flew-*con*-a-zole  *diff*-loo-can

Foscarnet (Foscavir)
foss-*kar*-net  *foss*-ka-veer

Ganciclovir  (Cymevene)
gann-*sike*-low-veer  *sigh*-muv-veen

Indinavir  (Crixivan)
in-*din*-ner-veer  *cricks*-siv-van

Isoniazid
eye-son-*nye*-is-zid

Itraconazole (Sporanox)
it-rah-*con*-a-zole  *spor*-an-ox

Ketoconazole (Nizoral)
ket-toe-*kon*-a-zole  *niz*-zor-al

Liposomal daunorubicin (DaunoXome)
lipp-oh-*so*-mul dawn-a-*rube*-is-sin  *dawn*-ox-home

Liposomal doxorubicin (Caelyx, Doxil)
lipp-oh-*so*-mul docs-a-*rube*-is-sin  *kay*-licks  *doc*-sill

Loviride
*lovv*-ear-ride

Nelfinavir (Viracept)
nell-*finn*-a-veer  *vye*-rus-sept

Nevirapine (Viramune)
nuh-*veer*-a-peen  *veer*-a-mune

Pentamidine (Nebupent, Pentam)
penn-*tam*-a-dean  *nebb*-you-pent  *penn*-tam

Protease inhibitor
*pro*-tee-ayse in-*hib*-it-teh

Pyrimethamine (Daraprim)
peer-ee-*meth*-a-mean  *dar*-ra-prim

Reverse transcriptase
ruh-*verse* tran-*script*-ayse

Rifabutin (Mycobutin)
riff-fab-*you*-tin  mike-obe-*you*-tin

Rifampicin (Rifadin, Rimactane)
riff-*amp*-ass-in  *rife*-ed-in  rim-*mac*-tain

Ritonavir (Norvir)
rit-*on*-a-veer  *nor*-veer

Saquinavir (Invirase)
sack-*win*-a-veer  *in*-veer-aze

Stavudine (Zerit)
*stav*-you-dean  *zeh*-rit

Trimetrexate (Neutrexin)
try-muh-*trecks*-eight  new-*trecks*-in

Valaciclovir  (Valtrex)
val-lay-*sike*-low-veer  *val*-trecks

Vinblastine
vinn-*blass*-teen

Vincristine
vinn-*kriss*-teen


>>OPPORTUNISTIC DISEASES

Anogenital cancer
ay-no-*gen*-it-ul  *kan*-ser
[ay as in 'hay']

Aspergillosis
ass-per-jill-*oh*-sis

B19 parvovirus
bee-nine-teen *par*-vo-vye-rus

Blastomycosis
blas-toe-my-*ko*-siss

Candidiasis
kan-did-*eye*-a-siss

CMV
see-em-vee

Coccidioidomycosis
cock-id-ee-oide-o-my-*ko*-siss

Cryptococcus
krip-toe-*cock*-us

Cryptosporidiosis
krip-toe-spur-id-ee-*oh*-siss

Entamoeba histolytica
en-tem-*ee*-ba hiss-tul-*lit*-ick-uh

Giardia lamblia
*jar*-dia *lamm*-blee-uh

Gingivitis
gin-jiv-*eye*-tuss

Guillain-Barr syndrome
ghill-*aine* bar *sin*-drome
[ghill as in a fish's 'gills']

Hairy leukoplakia
*hair*-ee luke-oh-*plake*-ee-uh

Hepatitis B
hep-it-*tie*-tuss bee

Herpes simplex
*her*-pees *sim*-plecks

Histoplasmosis
hiss-toe-plaz-*mow*-siss

HIV encephalopathy
aitch-eye-vee en-keff-ah-*lop*-ah-thee
['th' as in 'thief']

Hodgkin's disease
*hodge*-kins diz-*ease*

Human papilloma virus
*huw*-mun  pap-ill-*oh*-muh  *vye*-rus

Isosporiasis
eye-zo-spor-*eye*-a-siss

Kaposi's sarcoma
kuh-*poe*-zeez sar-*ko*-muh

Leishmaniasis
leash-mun-*eye*-a-siss

Lymphocytic interstitial pneumonitis
lim-foe-*sit*-tick in-ter-*stish*-ul new-mow-*nigh*-tiss

MAI
em-ay-eye
[ay as in 'hay']

Microsporidiosis
mike-row-spur-id-ee-*oh*-siss

Molluscum contagiosum
mull-*oss*-kum kun-tay-jee-*oh*-sum
[jee as in 'jeans']

Neuropathy
nur-*o*-pa-thee
['nur' as in Nurafen, 'o' as in 'opera', 'th' as in 'thief']

Non Hodgkin lymphoma
non *hodge*-kin lim-*foam*-uh

Pancreatitis
pan-kree-a-*tie*-tuss

PCP (Pneumocystis carinii pneumonia)
pee-see-pee  new-mow-*siss*-tiss  ka-*rin*-ee-eye new-*mown*-ee-uh

Pelvic inflammatory disease
*pel*-vik in-*flam*-it-tree diz-*ease*

Persistent generalised lymphadenopathy
per-*siss*-tunt jenn-rul-eyes(d) lim-fad-un-*op*-uh-thee
['th' as in 'thief']

Progressive multifocal leukoencephalopathy
prug-*ress*-ivv mull-tea-*foke*-ull luke-oh-en-keff-ah-*lop*-ah-thee
['th' as in 'thief']

Psoriasis
sir-*rye*-uh-siss
['sir' as in 'yes sir']

Salmonellosis
sall-mun-ell-*oh*-siss

Seborrhoeic dermatitis
see-bear-*ee*-ick der-mat-*eye*-tuss

Syphilis
*siff*-ull-liss

Thrombocytopenia
throm-bow-sigh-toe-*pee*-knee-ah

Tinea
*tin*-knee-ah

Toxoplasmosis
tock-so-plaz-*mow*-siss

Tuberculosis
tue-ber-queue-*low*-siss

Varicella zoster virus
va-ree-*chell*-uh  *zos*-tuh *vye*-russ


***

NOTICEBOARD


>>TAT FORUM

The next forum organised by the Treatment Action Taskforce will examine complementary therapies with John Stevens, editor of the journal Equilibrium.

It takes place on Monday 25th November from 7pm to 9pm in Room 101 on the first floor of the University of London Union in Malet Street, London W1. Everyone is welcome.


>>ROYAL FREE STUDY

If you are considering starting treatment, you may be able to help advance scientific knowledge by joining a new study at the Royal Free Hospital in London.

Participants with CD4 counts that are either around 500 or around 50 will start combination therapy for one week, then stop all the drugs for one week, then restart therapy indefinitely. Extensive viral load tests will be performed. The study is designed to test whether HIV reproduces at a faster rate in people with low CD4 counts compared to those with high CD4 counts. If you take part you cannot expect any benefits or risks, but may help to improve our understanding of how HIV behaves in the body.

For more details contact Deborah Farmer on 0171-794 0500 bleep 660.


>>THT IN FRENCH

The Terrence Higgins Trust has produced a guide in French to its full range of services for people with HIV. Single copies are available from its Information Line on 0171-831 0330 from 2pm to 5pm daily.


>>SOCIAL ASPECTS

The Ninth Conference on the Social Aspects of AIDS will take place on 10th May 1997. More details are available from Michael Stephens, SIGMA Research, Eurolink Centre, 49 Effra Road, London SW2 1BZ.


>>NO ATU NEXT MONTH

There will be no AIDS Treatment Update published in December, to allow us to complete the thorough updating of NAM's HIV & AIDS Treatments Directory. The next issue of ATU will be a bumper-sized issue delivered in early January, including the latest news from the Third International Congress on Drug Therapy in HIV Infection, a report on the dramatic reductions in disease and death observed in the USA since protease inhibitors became available, and a round-up of new clinical trials throughout the UK.


***


GLOSSARY

CD4 A molecule on the surface of some cells onto which HIV can bind. The CD4 cell count roughly reflects the state of the immune system
clinical event The occurrence of a physical sign or symptom, rather than an abnormality that can only be detected by laboratory tests
combination therapy Using more than one drug at a time
expanded access scheme A programme that allows access to an experimental drug outside clinical trials for people in particular need
liver An organ involved in digestion of food and excretion of waste products from the body
monotherapy Taking a drug on its own, as opposed to in combination with other drugs
nucleoside One of the building blocks from which DNA and RNA are made. Nucleoside analogue drugs such as AZT resemble one of these building blocks
prophylaxis Using drugs to try to prevent or delay an illness
protease An enzyme that HIV uses to break up large proteins into smaller ones from which new HIV particles can be made
reverse transcriptase A retroviral enzyme which converts genetic material from RNA into DNA, an essential step in the lifecycle of HIV
surrogate marker An indirect indicator of something such as the effect of a drug
treatment-naive Someone who has never taken anti-HIV drugs
viral load A measurement of the amount of virus in a sample

***

AIDS Treatment Update is published monthly by
NAM Publications, 16a Clapham Common Southside, London SW4 7AB.
Tel: 0171-627 3200. Fax: 0171-627 3101. E-mail: atu@nam.org.uk
Internet: http://www.nam.org.uk/nam/

Copyright NAM Publications, 1996.

Editor: Edward King.

Medical Advisory Panel: Dr Fiona Boag, Dr Ray Brettle, Dr Janet Darbyshire, Dr Martin Fisher, Dr Brian Gazzard, Dr Diana Gibb, Professor Paul Griffiths, Dr Margaret Johnson, Dr Jacqueline Mok, Dr Graeme Moyle, Professor Tony Pinching, Professor Jonathan Weber, Dr Ian Williams, Dr Mike Youle.

Postal subscriptions are free to individuals in the UK affected by HIV or AIDS. Professional/organisational rate: L40/year. For all overseas subscriptions, within EU add L5/year; outside EU add L15/year.

Reproduction and distribution of articles from AIDS Treatment Update is encouraged on condition that it is on a non-commercial basis and that articles are reprinted unedited and in full, including these credits.
