A study published November 21 in Science1 is generating
considerable scientific interest, and suggests possible
treatment strategies for both early and more advanced HIV
infection. While this study itself is one small building
block among a number of important advances toward the
understanding of how the body first controls HIV infection
but later usually fails to do so, its publication seems to
mark a time of change toward integration of virological and
immunological approaches, away from the relative neglect of
immunology and domination of HIV research by virology.
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The picture emerging from this and other studies is that in
most cases of HIV infection, the T-helper cells which respond
specifically to HIV (and help to bring down the very high
viral load which develops during primary HIV infection) seem
to be lost or stop working early in the disease process. The
new study examined long-term nonprogressors, and found that
in them, this specific T-helper response against HIV remained
strong. In other persons with HIV who were tested, this
response correlated strongly with low viral load (much more
strongly than CD4 count correlated with viral load),
suggesting that specific T-helper response to HIV is
important in the body's control of the virus. Why the
specific anti-HIV activity is lost is unknown; it is possible
that the cells which recognize HIV are activated and
therefore easily infected at the time of high viral levels
during primary infection.
Two practical consequences have been suggested by a number of
researchers:
(1) Effective antiretroviral treatment early enough -- probably
during primary infection with a regimen including protease
inhibitors -- may allow the specific anti-HIV responses to be
preserved, as they seem to be in long-term nonprogressors.
Early experience from treatment of patients during primary
infection supports this possibility.
(2) Later in HIV disease, antiviral treatment which results
in undetectable viral load generally does not lead
automatically to the return of these specific anti-HIV T-
helper cells. However, there is reason to believe that they
still could be induced by vaccination while the infectious
virus is suppressed by antiretrovirals. Several approaches --
killed-virus vaccine, certain HIV antigens produced by
genetic engineering, or DNA vaccines -- are feasible to try
now.
References
Rosenberg ES, Billingsley JM, Caliendo AM, Boswell SL, Sax
PE, Kalams SA, and Walker BD. Vigorous HIV-1-Specific CD4+ T
Cell Responses Associated with Control of Viremia. Science
November 21, 1997, volume 278, pages 1447-1450. Also see
commentary in the same issue, "How does HIV overcome the
body's T cell bodyguards?," by Michael Balter, pages 1399-
1400.
New Meeting on Immune Surrogate Markers
Baltimore, January 9-11
A new meeting on "the identification of meaningful surrogate
markers of immune reconstitution" will be hosted next month
by the Institute of Human Virology and the University of
Maryland Foundation. This conference has been called on short
notice, so help is needed in getting the word out. The
steering committee of about 20 leading researchers includes
Larry Fox, Robert Gallo, Alan Landay, Michael Lederman,
Robert Redfield, Nara Sarver, Fred Valentine, and Bruce
Walker. Cosponsoring organizations are the Harvard AIDS
Institute, Pacific Oaks Medical Group, Project Inform, and
Search for a Cure.
The "First Annual Immune Function and Surrogate Markers:
Setting the Goal Line" will take place at the University of
Maryland, Baltimore campus; rooms have been reserved at the
Hyatt Regency Baltimore. Conference registration is $200 for
academic registrants, $300 for corporate. Registration is
requested if possible by December 15.
For more information, including the program and the
registration form, contact Jeffrey Meshulam, Institute of
Human Virology, 410-706-8614, fax 410-706-1952, email
ihvinfo@umbi.umd.edu.
FDA Approves New Kind of Lymphoma Treatment
by John S. James and Greg Dubs, Ph.D.
On November 26 the FDA approved rituximab (Rituxan™), a
monoclonal antibody, for treating certain kinds of non-
Hodgkin's lymphoma. While not a cure, it appears to be an
important treatment advance; also, it is the first monoclonal
antibody approved to treat cancer, at least in the U.S. It
has not yet been tested in persons with HIV, but such trials
are now being organized. The official approval is only "for
the treatment of patients with relapsed or refractory low-
grade or follicular, CD20 positive, B-cell non-Hodgkin's
lymphoma"; however, the drug is likely to be useful for some
other lymphomas as well. (HIV-related lymphoma is usually
high grade.)
Rituximab works by killing B-cells, both normal and
cancerous; the body can replace the normal cells after
several months. B-cells produce antibodies for fighting
certain infections, but no increase in infections has been
found so far. Side effects of this treatment are usually much
less than with conventional chemotherapy.
In one trial in 166 patients with relapsed or refractory low-
grade non-Hodgkin's lymphoma (those with large tumors were
excluded from this study), 6% of the volunteers had a
complete response, and 42% had a partial response.1 In
another trial, 46% of patients responded to rituximab
treatment after they had failed conventional therapy; of the
17 responders, 14 had partial remission and three had
complete remission.2
Combination use with chemotherapy seemed to work especially
well in another trial.3 Forty volunteers with low-grade
lymphoma were entered, 80% of them with no prior therapy. Of
the 35 who completed the treatment, the response rate was
100% (60% complete response and 40% partial response). Of the
other five, two did not receive treatment, and the three
others had a partial response.
In addition, there is laboratory evidence that the antibody
may re-sensitize tumor cells that had become resistant to the
chemotherapy.4
There is concern that rituximab might be dangerous if used as
initial therapy if there is a high tumor burden, because of
possible toxicity from killing too many B-cells at once. To
avoid this, other treatment may be used first to reduce the
tumor burden. There is interest in not waiting for the
chemotherapy to fail (as the officially approved indication
suggests), but instead using the antibody sooner.
The approved rituximab treatment is four doses over a 22-day
period -- because this is what was used most in the important
clinical trials. Unfortunately, the drug price to physicians
for the four-course treatment is about $11,000; it is
expected that insurance will pay in some cases, but be a
problem in others. Rituximab was discovered by IDEC
Pharmaceuticals Corp., and developed by IDEC and Genentech
Inc. It is being marketed in the U.S. by Genentech.
Genentech has established a toll-free number to help with
reimbursement problems, and has an Uninsured Patients
Assistance Program to "provide assistance to patients whose
physicians recommended treatment with Rituxan, regardless of
the patients' economic or insurance status." We do not have
the phone numbers or additional information at press time.
A newly formed Lymphoma Action Group began shortly before the
approval. It will be working especially on increasing access
to the drug, particularly for persons with HIV or others with
high-grade lymphoma (who may need the most help with access,
since the official indication is for low grade). To contact
the group, leave a message at 415-790-5716.
Maloney DG, Grillo-Lopez AJ, White CA and others. IDEC-
C2B8 (Rituximab) anti-CD20 monoclonal antibody therapy in
patients with relapsed low-grade non-Hodgkin's lymphoma.
Blood September 15, 1997, volume 90, number 6, pages 2188-
2195.
Czuczman M, Grillo-Lopez AJ, White CA and others. IDEC-
C2B8/CHOP chemoimmunotherapy in patients with low-grade
lymphoma: clinical and BCL-2 (PCR) final results. Blood
November 15, 1996; volume 88, number 10 (supplement 1),
abstract #1799.
Demidem A, Lam T, Alas S, Hariharan K, Hanna N, and
Bonavida B. Chimeric Anti-CD20 (IDEC-C2B8) Monoclonal
antibody sensitizes a B cell lymphoma cell line to cell
killing by cytotoxic drugs. Cancer Biotherapy & Radiopharmaceuticals 1997; volume 12, number 3, pages 177-186.
Major AIDS Institute Inaugurated in San Francisco
On December 1 the University of California San Francisco
(UCSF) officially inaugurated the AIDS Research Institute,
"the largest AIDS initiative anywhere outside of the National
Institutes of Health." This effort brings together all
existing AIDS programs at the University, and has a strong
focus on multidisciplinary research.
"The next generation of answers requires a deeper level of
collaboration," said Thomas Coates, Ph.D., director of the
Institute, and professor of medicine, epidemiology, and
statistics at UCSF. "The important answers will come at the
interface of the sciences. It's clear we cannot answer
clinically important questions without bringing people
together."
The AIDS Research Institute will provide "both financial and
practical support for a broad range of initiatives, including
vaccine research, development of new therapies, studies of
transmission dynamics, prevention science, AIDS policy and
ethics research, a new clinical virology and immunology lab,
and international and community studies. It will also provide
the mechanism for meetings of scientific minds through town
hall forums, peer review sessions, focus groups and 'targeted
action groups,' in which a dozen or so researchers will meet
to plan multidisciplinary studies."
The executive committee consists of Haile T. Debas, M.D.
(Chancellor and Dean of the School of Medicine at UCSF),
Margaret A. Chesney, Ph.D., Thomas J. Coates, Ph.D., Warner
C. Greene, M.D., Ph.D., John S. Greenspan, B.Sc., B.D.S.,
Ph.D., Jay A. Levy, M.D., Paul A. Volberding, M.D., and Diane
W. Wara, M.D.
Basic information on the four HIV protease inhibitors
approved in the U.S. has been published in a fold-out
brochure by the U.S. Food and Drug Administration, entitled
The Protease Inhibitor Backgrounder. Copies are available
without charge.
The current edition, last updated in October, includes
information on dosage, relation to food, storage
requirements, warnings and precautions, most frequent adverse
effects, pediatric use, medications that should not be used
with each protease inhibitor, and drug interactions requiring
dose adjustment. There is also a list of suspected
interactions, especially with ritonavir (suspected due to the
metabolism of the drugs, although clinical trials to check
for these interactions have not been done), and advice on
reducing risk if these combinations must be used. Some
information on dosing when using two protease inhibitors
simultaneously is provided in this section.
The reading level is appropriate for medical staff or
informed patients.
Comment: This authoritative and non-promotional publication
will help patients understand their options, and also help
assure that instructions provided with protease-inhibitor
prescriptions are correctly understood. Failure to follow
instructions for use of drugs is a major problem in medicine,
and the consequences are especially serious with HIV
treatments, particularly protease inhibitors. Sometimes the
instructions are not followed because the patient never
understood them. And sometimes instructions are wrong, as
when drugs are combined incorrectly. This brochure will help
assure that patients understand the instructions, and may
bring potential errors to the attention of medical staff.
The Protease Backgrounder is available on the World Wide Web
under FDA's HIV/AIDS Therapeutic Index, found at:
http://www.fda.gov/oashi/aids/piindex.shtml, or by calling the FDA Office of Special Health Issues at 301-827-4460.
Protease Inhibitor Failure Trial
Combination 1592, 141W94, and Efavirenz
Persons with detectable viral load despite treatment with
combination therapy which includes a protease inhibitor are
receiving a combination of three new antiretrovirals, in a
phase II multicenter study organized by Glaxo Wellcome and
now being conducted in nine U.S. cities. As this issue of
AIDS Treatment News went to press with an announcement, we
learned that the trial as originally designed is
oversubscribed, although it started recruiting only in
November. There has been discussion about possibly expanding
the number of patients, but no decision has been made.
Volunteers are 13 or older, with viral load over 500 copies
despite treatment including a protease inhibitor. They must
have been receiving the same protease inhibitor(s) for the
most recent 12 weeks and continuing until the start of the
study medication. They must not have used 1592, 141W94, or
efavirenz (also called SUSTIVA™, or DMP-266) before; also,
certain other treatments must not have been used within 30
days. There are other criteria, including no AIDS-defining
opportunistic infection or malignancy except Kaposi's
sarcoma, and a negative pregnancy test for women.
This is an open-label study, meaning everyone receives the
three medications. There is no randomization or control
group. The goal is to study the antiviral activity of the
drug combination, and also its safety and tolerability, when
existing regimens do not fully control the virus.
Each of these drugs has side effects. For each one, rash is
the most common reason for which the drug has had to be
discontinued.
New AIDS Bookstore on World Wide Web
by John S. James
Immunet, a nonprofit HIV and AIDS education organization
which runs the Web site http://www.immunet.org, opened an
online AIDS bookstore on December 1. This is a valuable
resource, both for obtaining AIDS books which otherwise may
be hard to find, and as a free research tool to see what is
available. As of December 2, this site lists 3,059 AIDS books
which can be ordered online, and includes reviews of 547 of
them.
This site is also noteworthy as an example of a kind of
online business and community structure which we believe will
become much more important over the next few years, and which
is likely to have other uses in AIDS, including buyers clubs
and possibly pharmacies.
How to Use the Site
From the Immunet home page, select the Online Bookstore; most
users will then search for books by one or more keywords. As
a test, we entered "nutrition" and found 36 books on AIDS and
nutrition; a search on "pathogenesis" found 27 books. Most of
the books we found have reviews available. You can also
search for author by entering a last name as a keyword.
For each book, you can read the review if any, and can obtain
ordering information, including price and an estimate of how
long it will take to be shipped (usually a few days, but if
delivery is likely to be delayed, you know that before
placing the order).
The reviews are provided by the AIDS Book Review Journal, of the University of Illinois. Orders are processed and shipped
by Amazon.com, a large and well-known online bookstore.
It is no accident that most of the books which were found in
our searches do have reviews. This is because the search will
examine the title, and also the review if there is one; and
it is more likely that the exact word being sought will occur
somewhere in a lengthy review of a relevant book, than in the
much shorter title. The "nutrition" search, for example,
found 24 books that were reviewed and 12 that were not; all
of the books that were not reviewed had "nutrition" (or
"nutritional") in the title, or they would not have been
found. This system works for most users, because presumably
the most important books are likely to be reviewed, and yet
the others can be found as well.
As of December 2 the list of non-reviewed AIDS books is
preliminary and appears to have been computer generated.
Suggestions for improvement -- especially books that should be
listed but are missing -- can be sent to Gary Schaff,
gschaff@immunet.org, or to Tony Brooks, tbrooks@immunet.org.
Comment: Community Building
A major key to successful Web sites is community building.
Large merchandising organizations are seldom good at that. On
the other hand, community-based or specialized interest
groups are seldom effective at running a large business
efficiently (processing orders, shipping books, building
relationships with suppliers, etc.); this is not what they
want to do. Unlike other media, the World Wide Web allows
orders to be passed from the community organization to the
merchandiser with zero cost and zero delay.
All the parties can benefit. The community group earns a
referral fee for orders it generates (5 to 15%, according to
Immunet's press release), without having to process or ship
the orders -- creating a fundraising tool for organizations.
The merchandiser receives orders with guaranteed profit, as
there is no up-front cost for advertising or promotion.
Customers can use a site built around their needs and
interests, and still receive discounts and pay no more than
if they placed their orders elsewhere.
Ultimately the negotiating leverage rests with the community
organizations, not the merchandisers, even when the latter
are much larger entities. For as the online market develops,
there will be a number of competing merchandisers, all
offering about the same prices and services. A community
group can take its business to any of them; there is no
"Microsoft effect," no natural monopoly based on a mutual
benefit in everybody using the same system. But while
merchandisers are generic, each community is unique; whoever
brings the people has the controlling advantage. This
dynamic can provide some antidote to the increasing
centralization and remoteness of modern institutions.
We believe that this kind of arrangement could be important
for AIDS or other buyers' clubs -- which could offer huge
selections at low prices by referring fulfillment of routine
orders to selected commercial suppliers, while shipping the
most specialized orders themselves.
Revised Federal Antiretroviral Treatment Guidelines
Guidelines for the Use of Antiretroviral Agents in HIV Infected Adults and Adolescents, the influential guidelines
of a panel organized by the U.S. Department of Health & Human
Services, were first published in draft form on June 19,
1997. A revised version dated November 5 is now available at
a number of sites on the Web.
The new Web site of the University of California San
Francisco, http://hivinsite.ucsf.edu/, has links to the new draft, both the official release with the original graphics,
and also in a Web format more convenient for many users. In
addition, it has links to about a dozen other major AIDS-
related treatment guideline documents.
After three years of attempts, Congressional efforts to
change the law under which FDA operates achieved bipartisan
consensus. The result, the FDA Modernization Act of 1997, was
signed into law by President Clinton on November 21. Major
provisions are:
"Fast track" review for the most important drugs -- those
"intended for the treatment of a serious or life-threatening
condition and [which demonstrate] the potential to address
unmet medical needs for such a condition." Drug companies
must apply for fast-track status -- which they may do when they
apply for an IND (permission to test the drug in humans) or
any time afterwards -- and then the FDA must decide within 60
days whether to grant it. The fast-track section is closely
based on procedures the FDA has already developed and used
for accelerated approval of some AIDS and cancer treatments.
The new law encourages the development of new surrogate
markers of drug efficacy; however, fast-track status can
apply whether or not surrogate markers are used.
Allowing drug companies to promote "off label" drug uses by
sending peer-reviewed articles to physicians; this is
probably the most controversial major provision of the law.
Also, companies will be allowed to make economic claims to
HMOs (health maintenance organizations) -- but not to patients
or physicians -- without running controlled clinical trials, as
previously required, which would often be impractical or
unethical.
Changing the mission of the FDA. In addition to protecting
the public from unsafe drugs, its mission now will also be to
speed research, innovation, and access to care.
Renewing PDUFA (the Prescription Drug User Fee Act), which
allows the FDA to charge companies for reviewing their drugs,
and use the money to hire more reviewers so that approval
decisions can be made more quickly. PDUFA has been a huge
success and is universally supported -- especially by the
companies which have to pay the fees, since the advantage of
earlier approval greatly outweighs the cost. PDUFA would
almost certainly have been renewed in any case, but was
delayed by the politics around other aspects of the bill.
Legislation on compounding of drugs by pharmacists or
physicians. According to Julie Gossman of Emord and
Associates, a law firm in Washington D.C., the new law
regulates the current practice of compounding, and should not
cause major changes there.
Substantial legislation in other areas, including medical
devices, and health claims for foods.
Also, there can always be "sleepers," inconspicuous phrases
which are added by special interests and become law by
surprise. Today it is common that neither the public nor
members of Congress know exactly what is in a major bill when
the final vote is taken.
The bill will probably not fix the very serious delays
early in the development process, when an experimental drug
is first entering clinical trials. This issue unfortunately
dropped out of the discussion early on, and has never
received sustained national attention. It is hard to build
political momentum around events which occur early, before a
compound has become a therapeutic option for people.
Most AIDS organizations and activists have not been involved
in the discussion and debate about this bill. Of those who
were involved, most were strongly opposed; they worked
through a new group called the Patients' Coalition. One
organization, the Log Cabin Republicans, strongly supported
the bill.
Comment
We doubt that the new law will have a major near-term impact
on AIDS drug development, since the fast-track provisions
mostly legislate what the FDA has done already for the most
clearly important AIDS drugs. The law should, however,
encourage more attention to surrogate markers for drugs other
than antiretrovirals -- for AIDS and other serious illnesses as
well.
The other big change, allowing limited promotion of off-label
uses, has become framed as a debate between consumer
protectionists and industry. ("Off-label" use means that a
drug approved by the FDA for one use is prescribed by doctors
for another purpose. It has long been recognized as legal and
proper for physicians to do this; however, pharmaceutical
companies could not promote such uses. They could give
doctors peer-reviewed articles if asked, but could not take
the initiative to provide them, even to a doctor.) Opponents
say that the new law will allow companies to profit from uses
not proved safe and effective, will remove incentive for
companies to get their drugs approved for new uses, and will
result in more prescriptions not being covered by insurance.
They fear that companies could start promoting new uses just
by announcing that they will file an IND, doing the minimal
paperwork, and repeating the process whenever necessary; the
law requires an IND (so that the offlabel uses will be
researched and, if proven, come onto the label), but cannot
stipulate that the IND be a credible one. On the other side,
industry sees the new revenue streams from off-label uses as
particularly important to small biotech companies which can
only afford to go for one approval at a time.
What needs more attention is the apparently large number of
people with serious health problems which could be
successfully treated with available drugs, but who are never
told that by their doctors, even though credible evidence has
been published. The number of cases of people who learn by
happenstance, through friends, newsletters, or noticing a
story in the news, suggests that there are probably hundreds
of thousands, possibly millions, who could benefit
substantially from known off-label uses of available drugs,
but who are not receiving that help today. Most doctors will
not bring up treatments which are outside the mainstream and
are not promoted.
In recent years the FDA has made it easier for companies to
get these new indications approved, which is commendable; but
many valid uses will never be submitted for approval (with or
without the new legislation), especially if they are
inexpensive and therefore will not generate revenue to cover
development costs. The new law may have created the first
institutional incentive to bring such treatments into use.
Hopefully industry will use this new power responsibly -- and
medical and public-service organizations will be ready to
call companies on any abuses.
Press Must Register Now to Cover February Retroviruses Meeting
December 29 Deadline
by John S. James
Next year's major AIDS research conference in the United
States will be held at the Sheraton Chicago Hotel, February
1-5, 1998; reporters must register over a month in advance in
order to be admitted. On December 1 the conference
secretariat released a "Press Registration" memo with
information about the conference, and a "Press Registration
Information" sheet with specific instructions. Due to the
delayed notice and the importance of the meeting, we include
the instructions here:
"5th Conference on Retroviruses and Opportunistic Infections,
Press Registration Information:
"Press registration applications will be reviewed by members
of the Scientific Program Committee. Applications from
community newsletters will be reviewed by the Community
Liaison Subcommittee. All press must preregister. There will
be no on-site registration.
"Who May Register
"Representatives from the following media may register as
press:
"Medical communications companies, financial press,
biotechnology newsletters, public relations firms, and
noneditorial staff such as publishers and representatives of
sales, marketing, or advertising departments are not eligible
for press registration. Individuals, agents, or contractors
providing coverage for or being sponsored by industry may not
register as press.
"Freelance writers should provide proper credentials as well
as a letter of assignment from a publication. Unassigned
freelance writers may not register as press.
"Any publication, supplement, or electronic product devoted
exclusively to the coverage of the conference must have prior
written approval of the Scientific Program Committee (e.g.,
meeting highlights, on-line conference proceedings/reporting,
audio conferences, etc.). Media campaigns at the conference
and distribution of company-sponsored press releases (both at
the conference and off-site) are not permitted preceding or
during the meeting dates.
"How Many May Register
"Press registration is limited to 180. Up to two reporters
per publication, publication group or electronic news-media
service may register as press. Applications for a second
reporter will be considered after all other requests have
been received, and registration privileges will be provided
if the limit has not already been reached. Additional badges
(above the allotment of 2 per media outlet) providing
admittance to press conferences will be available for
television crews.
"How To Register
"Requests for press registration should be submitted
(preferably on the attached registration form) along with the
materials listed below:
"Press who have been credentialed for the conference in the
past 2 years should include:
"1. a letter from the editor (or masthead with reporter's
name listed)
"2. sample of a recent article (preferably from the last
Retrovirus Conference, demonstrating previous coverage, and
with a byline)
"Press who have not registered for previous Retrovirus
Conferences should include:
"1. a letter from the editor
"2. copy of one recent article (published within the past
year and preferably with a byline)
"3. sample publication
"Send the above materials to:
Press Registration
Retrovirus Conference Secretariat
211 N. Union St., Suite 100
Alexandria, VA 22314
(703) 684-4876 phone / (703) 684-4841 fax
"Deadline
"The deadline for press registration is December 29, 1997 (or
until the press block has filled, whichever occurs sooner).
All applications will be handled on a first-come, first-
served basis. Within two weeks of receipt of press
application and after press credentials have been reviewed
and approved, a confirmation letter and housing information
will be sent. A press kit and final program and abstracts
book will be sent two weeks prior to the Conference to all
preregistered press."
Note: There is no registration fee for press. But persons
cannot register for this conference just by paying a fee;
they must be a member of an allowed category, such as one of
the press categories above. It is unclear where gay
newspapers and perhaps certain other media will fit, and this
may be a problem; our understanding is that "community-based
newsletters" are expected to be AIDS-specific.
The 5th Conference on Retroviruses and Opportunistic
Infections "is sponsored by the Foundation for Retrovirology
and Human Health and is held in scientific collaboration with
the National Institute of Allergy and Infectious Diseases
(NIAID) and the Centers for Disease Control and Prevention
(CDC)." The secretariat is the Westover Management Group,
703-684-4876, fax 703-684-4841.
Correction: FORTOVASE Information Number for Patients in Washington D.C. Area
Our last issue published two Hoffmann-La Roche numbers for
patients seeking information about FORTOVASE, the new
saquinavir formulation which was approved by the FDA on
November 7. The national toll-free number was correct; but
the Washington D.C. telephone number for local patients only
is not in service. Callers in the Washington area should use
the national number, 800-910-4687, Monday through Friday 9:00
a.m.- 6:00 p.m. Eastern time.
December Deadline for Charitable Giving and Tax Relief
by John S. James
The traditional season for giving is also the best time for
those who have done well financially during the year to make
charitable contributions which can reduce their taxes. This
is because the year's financial picture is mostly in view,
yet there is still time to contribute within the 1997
calendar year. Successful investors may find particular
advantage in donating appreciated securities, since they can
avoid capital gains tax while also increasing their
charitable deduction.
One charity we suggest is AIDS Treatment News Associates,
584-B Castro Street, San Francisco, CA 94114. A 501(c)(3)
organization, ATNA reimburses free subscriptions for persons
who cannot afford to pay for AIDS Treatment News.
Contributions to ATNA relieve us of a serious financial
burden, since AIDS Treatment News has never turned people
away but sends free subscriptions at our expense when
necessary. And to guard our independence we do not accept
pharmaceutical-company contributions, even for charitable
purposes.
The changing epidemic during the last several years has meant
that more people who need and request this information cannot
pay even the cost of printing and mailing their newsletter;
we have become payers of last resort. We need assistance to
avoid spending more and more time working around financial
constraints, time we could better devote to our work.
For more information, contact me at AIDS Treatment News, or
at 415-255-6259.
ISSN # 1052-4207
Copyright 1997 by John S. James. Permission granted for noncommercial reproduction, provided that our address
and phone number are included if more than short quotations are used.
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