PLANS FOR 1990

A year ago, AIDS TREATMENT NEWS published a list of treatments to watch in 1989 (see "Last Year's Predictions," below). This year we are less confident about which treatments may be important -- although there are some clear candidates, including ddI, ddC, AzdU, compound Q, and hypericin, among the antivirals. We are less confident than last year about predicting for the year ahead, because so much is happening that it is impossible to
follow all relevant developments.

We did select three developments which, in addition to the resource problems we outlined in our last issue, we believe will be important in 1990:

(1) Viral Tests for Rapid Drug Trials

Existing clinical trials for antivirals (ddI, ddC, and others to follow) are typically planned to run for two years, but may take much longer because they must recruit hundreds of people before the two-year timer begins. These study designs are highly inefficient because they rely on body counts -- deaths or other serious events -- in those not being treated. Therefore the pace is set by the slow progression of AIDS, regardless of how well the new drug works.

We are now on the verge of having better blood tests which will allow researchers to get the same level of statistical proof (of antiviral efficacy in humans) in weeks instead of years, and with far fewer subjects -- probably less than a tenth as many as needed today. Such trials could be done now. The tests required are somewhat difficult and expensive; better ones should become available in the future.

The AIDS community must follow this development closely, because the normal forces of inertia which slow the acceptance of any new way of doing things could in this case cost many lives. Federal officials or others may insist that body counts are still necessary to be absolutely sure that the drug, combination or other treatment improves survival, even after safety and antiviral efficacy in patients are well established. No proper weighing of costs and benefits could justify delaying all new antivirals for years because of the small chance that one of them might not save lives even after it shows clear antiviral activity in humans.

For more information about new viral tests for rapid drug trials, see the article below.

(2) Affordable Treatments for the Third World

Almost no research anywhere in the world is developing treatment options for Africa or elsewhere (including the Third World nation of poverty within the United States) where people cannot afford AZT-scale drug prices. Most of the world is being written off.

But occasionally an affordable treatment possibility accidentally appears. The most important example today is ddC (2',3'-dideoxycytidine -- see "ddC: The Low-Cost Antiviral," in AIDS TREATMENT NEWS #89, October 20, 1989). Now in major U. S. trials in very low doses, ddC may be at least as valuable as AZT or ddI -- but it costs pennies a day, is widely available from chemical supply houses throughout the world, and can be taken by mouth with little or no medical technology needed. The drug is dangerous if misused, but traditional healers in any culture could be trained to use it properly, whether or not Western medical infrastructure is available.

No organization in the world is developing ddC as a Third World treatment possibility. Therefore AIDS TREATMENT NEWS will help interested people find each other. To keep informed, write to: ddC Project, AIDS TREATMENT NEWS, P. O. Box 411256, San Francisco, CA 94141.

ddC is only one example. What is needed is an ongoing organization to find and develop the best possible treatment options for those who are otherwise excluded from AIDS/HIV treatment for economic reasons.

(3) The Sixth International Conference on AIDS, June 20-24 in San Francisco

Each year many if not most of the scientific papers on AIDS are presented at a giant international conference in June. Each January scientists rush to finish work and submit abstracts before the deadline (January 20 this year). The 1990 meeting is in San Francisco; previous meetings were in Montreal, Stockholm, Washington, Paris, and Atlanta. In San Francisco there may also be a meeting of NGOs (non-governmental organizations) before the conference, as there was last year in Montreal.

To avoid overcrowding, the international conference will only admit 12,000 paid registrants; to be sure to get in, persons should register early.

This year's international conference differs from the previous ones in that it is not co-sponsored by the government of the host country. The School of Medicine of the University of California San Francisco is responsible for planning, funding, and conducting the event.

This year's conference also differs from all previous ones in that it is threatened by U. S. government rules which make it difficult and possibly dangerous for persons with HIV to enter the United States, even for a few days for a scientific conference. They must apply for a special waiver, a difficult procedure as there are no clear standards of what constitutes an acceptable application, and therefore no clear end to the work needed to gather supporting evidence. In addition, persons will have their passport stamped with a code which identifies them as HIV-positive, and may subject them to discrimination in their own countries or elsewhere.

Organizations which have withdrawn from the conference as a result of this policy include the European AIDS Service Organizations, the League of Red Cross and Red Crescent Societies, the Scandinavian AIDS and HIV organizations, British Hemophilia Society, Canadian Hemophilia Society, British Frontliners, British Red Cross, Norwegian Red Cross, several member organizations of the UK NGO AIDS Consortium, and in the U. S., the National
Association of People With AIDS.

It is commonly believed that the travel restrictions which already are disrupting planning for the conference were imposed by an act of Congress in 1987. But according to Steve Morin, legislative assistant to Congresswoman Nancy Pelosi (Democrat, San Francisco), the documentary history clearly shows that the intent of Congress was to restrict only permanent or long-term residents, not short-term visitors. Apparently the law passed by Congress was misinterpreted by Federal officials who wrote the regulations.

Last Year's Treatment Predictions

A year ago, AIDS TREATMENT NEWS #72 (January 13, 1989) listed the following nine treatments to watch in 1989:

* ddI

* passive immunotherapy

* hypericin

* compound Q

* Chinese anti-infection herbs

* FLT (fluorodeoxythymidine)

* AzdU

* D4T

* Soluble CD4

To evaluate our predictions in detail would require researching the current status of all these treatments -- research effort which we would rather spend on other matters. Two of the treatments -- ddI and compound Q, both largely unknown a year ago--did receive major attention during 1989 and are still promising. We do not know of any of the nine which has been eliminated from consideration. But overall, we may have been too optimistic in expecting more in 1989 than would be accomplished.

In 1990 we hope that new methods of quantifying virus in the blood will allow rapid determination of whether proposed antivirals do or do not work -- and if so, how well they work--during actual use by patients.