From the Editor

This issue singles out three drugs for attention, for very
different reasons:

d4T (stavudine) is a close relative of AZT, but it may be
somewhat more effective and less toxic. It is important
because it will soon be more widely available, under a
"parallel track" protocol, for persons who have failed
treatment with AZT and with ddI. (Persons who are now using
AZT may be able to volunteer for a separate program, a
clinical trial comparing d4T and AZT, which is currently
running at sites throughout the U. S., and at sites in
Europe.)

Alpha APA (a class of anti-HIV drugs, of which one member, R
89439, has been selected for clinical development) is at a
much earlier stage of research; it has completed animal
toxicity tests, and the earliest safety tests in humans.
The next trials will be only in Europe, not in the U. S.
This drug deserves attention because it has very good
laboratory activity against HIV, and also is inexpensive to
manufacture, so that it could potentially be used in all
countries. The major possible drawback is that other drugs
with a similar mechanism of action have had serious problems
with HIV developing resistance; it is not known if that will
happen with this drug too. Alpha APA has been presented at
three scientific meetings, but has received little attention
so far.

The third drug, yohimbine, is not an antiviral; it is a
prescription drug with one approved use, treatment of
impotence in men. Recently there have been anecdotal but
dramatic reports from a handful of patients that yohimbine
relieved serious AIDS-related fatigue which could not be
diagnosed as due to any opportunistic infection or other
known cause. If this early and unexpected finding is
confirmed, the drug might have important use in improving
quality of life for some patients, and might even help in
understanding the pathogenesis of AIDS. More research is
needed, and community-based as well as academic research
groups could contribute.