NEWS NOTES

Senate Votes Overwhelmingly for AIDS Care

On May 15 the U. S. Senate voted 95 to 3 to override objections by Senator Jesse Helms, Republican of North Carolina, and vote on a bill to provide emergency disaster relief to cities and states with many AIDS cases. The next day, the Senate passed the bill by a vote of 95 to 4. The bill had been introduced by Senators Edward M. Kennedy, Democrat of Massachusetts, and Orrin Hatch, Republican of Utah; it has 65 other co-sponsors.
Much more is necessary before the bill becomes law -- especially the separate appropriations process in Congress. But the degree of consensus signals a welcome change in Washington on dealing with AIDS.
Most observers see two reasons for the change. First, more members of Congress now know someone with AIDS, or someone who has died of it. The second factor is the excellent work of the AIDS Action Council and other lobbying groups. They drafted solid, practical legislation representing a consensus on AIDS by dozens of major, mainstream health and medical organizations. NIAID Recommends Fluconazole for Cryptococcal Meningitis Maintenance Therapy
On May 11 the U. S. Public Health Service announced preliminary results of a clinical trial of fluconazole vs. amphotericin B for preventing recurrence of cryptococcal meningitis. All 205 patients in the trial had first been treated successfully with amphotericin B for the acute phase of the disease. Then they were randomly assigned to either fluconazole or amphotericin B for continuing treatment to prevent relapses.
Of 106 patients who received fluconazole (200 mg by mouth daily), only two developed recurrent cryptococcal meningitis, in a median time of 212 days. But of the 77 who received intravenous amphotericin B, 13 had relapses. (These numbers do not add up to the 205 patients total, because some could not be evaluated in the analysis.) Because of these results, the trial was ended, and all participants were offered fluconazole, which has far less toxicity than amphotericin B.
As a result of this study, the National Institute of Allergy and Infectious Diseases now recommends that fluconazole replace amphotericin B for maintenance therapy of cryptococcal meningitis.
NOTE: AIDS TREATMENT NEWS covered fluconazole treatment for cryptococcal meningitis in a five-page article almost three years ago, on September 25, 1987 (issue #41). At that time the drug had been used to treat over 2,000 people in Europe, mostly for less serious fungal infections; it had also worked well in the few cases in which it had been tried for cryptococcal meningitis. However, fluconazole was not approved in the United States until January 29 of this year. It is very expensive, and some people are using itraconazole instead. Itraconazole is not approved in the United States but is available in Mexico, and perhaps other countries, at a fraction of the U. S. fluconazole price. More information about itraconazole may be obtained from buyers' clubs; also see "Itraconazole: Affordable Fluconazole Substitute," AIDS TREATMENT NEWS #80, June 2, 1989.

AZT Early-Intervention Study Published

On May 15 the Annals of Internal Medicine published a formal report of ACTG 016, the major national study of persons with mildly symptomatic HIV and T-helper counts over 200. The results of this trial have already been incorporated into the recommendations concerning treatment of persons with T- helper counts between 200 and 500. While the conclusions are not new, the 11-page report includes many details which may be helpful to physicians in refining treatment strategies.

Reference

Fischl, M. D., Richman, D. D., Hansen, N. and others. The safety and efficacy of zidovudine (AZT) in the treatment of patients with mildly symptomatic human immunodeficiency virus type 1 (HIV) infection. A double-blind, placebo-controlled trial. Annals of Internal Medicine vol. 112, pages 727-737, May 15, 1990.

WHO Names New AIDS Program Director

On May 14 the World Health Organization (WHO) appointed Michael Merson, M. D., as head of the Global Programme on AIDS. He had been temporary head since March 26, when Dr. Jonathan Mann was forced out (see AIDS TREATMENT NEWS #99, March 16, 1990). Dr. Merson, a WHO employee for 12 years, directed its Control of Diarrheal Diseases Programme. He had also worked for the U. S. Centers for Disease Control (CDC).
WHO also appointed the deputy director of the CDC, Walter Dowdle, M. D., as consultant to Dr. Merson, when the latter assumed the interim position.