Newspaper Page Text
Page 12
AIDS FOCUS
Experimental AIDS Drugs: Should You Take Them and When?
Part 2 of a 2-part series
In Part 1 of this series (see Southern Voice,
Vd. I, No. 9), Terry Francis discussed the pros
and cons of taking experimental AIDS drugs and
the need for HIV positive persons to stay current
on the different approaches to treatment. In Part
2 of "Experimental AIDS Drugs", Francis
continues his analysis ofdextran sulfate and
other drugs currently available in this country.
Southern Voice neither advocates nor
endorses these drugs.
Dextran Sulfate
A promising drug that was given "high
priority" status by the National Institutes of Health
(NIH) last year, Dextran sulfate should finally
enter clinical trials in San Francisco later this
summer, but possibly only with persons who arc
asymptomatic. Research has been delayed due to
bureaucratic problems. Currently charges of
ineptness and mismanagement are flying at the
NIH and National Institute of Allergy and
Infectious Diseases(NIAID) over the handling of
Dextran sulfate.
Early reports indicate strong antiviral effects in
vitro, and trials overseas suggest Dextran sulfate
might work best in combination with other drugs.
Dr. Donald Abrams of San Francisco General
Hospital has satisfactorily completed a Phase I
toxicity trial.
In April a House subcommittee on human
resources held hearings to uncover reasons for the
delay of testing "high-priority" drugs such as
Dextran sulfate. Dr. Anthony Fauci, director of
NIAID, testified that lack of staff was responsible
for delays in beginning research. Dr. Thomas
Merigan who heads an AIDS Clinical Trial Unit
at Stanford University asserted that delays were
"NIH asserts that it is not
seeking to prevent sale of
Dextran Sulfate to
Americans in Japan or
prevent them from
inporting it into the U.S."
caused by problems ascertaining drug levels in the
bloodstream and choosing proper dosage. But a
trip before the House subcommittee apparently
helped to make blood measurements behave,
because San Francisco General's Phase n trial was
soon given the go-ahead. This is another instance
in which NIH and NIAID appear to not be living
up to their promise of keeping the public informed
on exactly why certain delays are taking place.
Dextran sulfate has been in use in Japan for at
least 20 years and is available there over-the-
counter. Americans may legally import a small
amount into this country for personal use. NIH
asserts that it is not seeking to prevent sale of
Dextran sulfate to Americans in Japan or prevent
them from importing it into the U.S.
"Living With AIDS," which
normally appears on the AIDS
Focus Page, will continue in future
issues. Submissions to "Living
With AIDS" are welcome from
PWAs, PWARCs, health
professionals and others affected
by the AIDS crisis.
Submissions should be no more
than 400 words in length, and
typed or legibly printed.
Mail submissions to:
Southern Voice
P.O. Box 54719
Atlanta, GA 30308
Dextran sulfate seems to work as an antiviral
by inhibiting replication of HIV and somehow
blocking the formation of syncytia (clumps of
white blood cells that form when an infected T-
cell bonds to other T-cclls, perhaps killing large
numbers of uninfected cells). Some researchers
believe that the formation of syncytia may play an
important role in HIV’s ability to impair the
immune system.
When used alone, Dextran sulfate appears to be
only modestly effective. Many researchers
believe the drug's worth lies in its synergy with
other antivirals. Los Angeles physician Dr.
Michael Scolaro has been following 30 patients
using Dextran sulfate. Nearly half have been
taking the drag for two months in combination
with various other substances such as AZT, AL
721 and acyclovir.
Dr. Scolaro reports that about 60% of those
using Dextran sulfate for at least two months have
shown improvements in lab values, including T-
cell counts. He cautions that the drug at this stage
appears less effective for persons whose counts
have fallen below 100. Readers should be
advised, however, that Dr. Scolaro's is not a
formalized test with controls. It is difficult to draw
meaningful conclusions from his optimistic
results.
"Workalikes" of Dextran sulfate are becoming
available in Canada and Mexico, the latter of
which should not be used. Persons interested in
learning more about Dextran sulfate may write to
Project Inform and the Gay Men's Health Crisis.
At doses taken for HTV, the drug is said to be non
toxic. San Francisco General has submitted a
protocol to study the drug in combination with
AZT, though approval has not been given. Some
persons in New York and San Francisco are
already combining the drugs.
Ampligen
Hopes are riding high on this drug (currently
undergoing trials in Atlanta) as both an antiviral
and immune booster. It appears so far to have
little or no side effects. In the Atlanta study,
principal investigator Dr. James Braude has
reported that he is seeing many patients improve
but not along a dramatic 50-50 split (the ARC
study is placebo controlled). A very preliminary
view of T-cell data on 32 patients after 5 months
shows that 12 are higher than baseline and 20
lower, of which 4 are only slightly lower. T-cell
increases have not been impressive.
Investigator David R. Strayer of Hahnemann
University has drawn conclusions from data
collected from persons taking Ampligen over a
longer period of time. He believes that Ampligen
can stabilize persons with ARC and over time
stabilize or gradually (if slightly) increase the
number of T-cells. He has observed mean T-cell
increases of 4% at 4 months; 8% at 8 months; and
17% at 12 months. Ampligen is available in drug
trials.
Scandalously, Ampligen is not currently under
study in combination with AZT. A study
published as early as April 18,1987 in Lancet
predicted that AZT plus Ampligen would reduce
the dose of AZT required for therapeutic effect
(i.e„ synergy), thus lessing exposure to AZT-
associated toxicity. The article went on,
"Moreover, since Ampligen has demonstrated
immunomodulatory activities clinically as well as
antiviral properties (both possibly mediated
through similar mechanisms), its use together with
AZT may have pronounced beneficial effects on
the course of AIDS beyond that which can be
estimated in vitro." I repeat; It is scandalous, and
no reasonable excuse has been offered, that tests
are not currently underway to determine the
efficacy of these drugs in combination.
Imuthiol (Antabuse)
Promising in early French studies, with reports
of persons experiencing significantly fewer
opportunistic infections. Reportedly doctors in
Paris and Lyons will give persons a six-month
supply of Imuthiol for free in exchange for mailing
them lab results performed in the U.S. (Contact
Gay Men's Health Crisis for updates on this).
Antabuse
Antabuse, a prescription drug related to
Imuthiol, might offer the same benefits. The hope
"It is scandalous,... that
tests are not currently
underway to determine the
efficacy of these drugs
(AZT and Ampligen) in
combination."
is that Antabuse will speed and protect the
maturation process of T-cells. There have been no
controlled studies of Antabuse, but informal
conversations with doctors suggest that after a
minimum of four months of therapy some persons
report rises in T-cell counts. A common dosage is
500 mg. every two weeks.
Antabuse is apparently most beneficial to
persons who are less sick. At the Atlanta HTV
symposium it was reported that one physician saw
40% of 39 patients on Antabuse have a 30%
increase in their T-cells after a slow response over
several months. However, this once again was not
a controlled study. Persons on Antabuse cannot
drink alcohol and should monitor their body's
exposure to products containing alcohol, such as
shampoos, moisturizers, cotton swabs used to wipe
skin for blood samples, foods, etc. Persons on
Antabuse also should have their liver enzymes
monitored at least every three months.
Naltrexone
A possible immune booster with no known side-
effects, and available on prescription. Information
on this drug is sketchy, but it is informally said to
possibly reduce the frequency and severity of
opportunistic infections. A study involving
Naltrexone is in the works for Atlanta (more about
this in the future). It does not appear to promote
viral replication of HIV, and is believed by some
to be an acceptable therapy for persons at early
stages of exposure. Tests to determine interferon
levels in the blood reveal whether or not
Naltrexone is working.
Alpha interferon
There has been some success using this drug
with persons who have Kaposi sarcoma. Early
tests indicate that 20-40% of patients respond to
alpha-interferon (side-effects include flu-like
symptoms which sometimes disappear after a few
weeks). Clinical trials are underway. In vitro the
drug appears synergistic with AZT. Persons
interested in acquiring alpha interferon should
have their physician contact NIH.
Aerosol pentamidine
This drug is being routinely administered as a
prophylaxis to persons who have already had PCP
and persons whose T-cclls liave fallen below 250.
Its success rate in preventing first and second
episodes of PCP Is being viewed as one of the
major advances in treating AIDS-related
infections. At the Atlanta HIV symposium it was
suggested that Aerosol Pentamidine be used in the
following manner: persons should use a nebulizer
(preferably not hand-held) that creates as fine a
mist as possible. Persons should inhale the drug
while reclining, but not lying flat, so that it will
have a better chance of reaching all parts of the
lungs.
Information on these and other drugs arc now
available from numerous sources, including the
Gay Men's Health Crisis, Department of Medical
Information, Box 274,143 West 24th Street, New
York City, NY 1001 Land Project Inform, 25
Taylor Street, Room 618, San Francisco, CA
94102. The toll-free national phone number is
(800) 822-7422.
- Terry Francis
A thoughtful article titled "Whether to Take
Experimental Drugs: Counseling Issues," has
been published in FOCUS-A Guide to AIDS
Research (a publication of The AIDS Health
Project, University of California San Francisco
and the Department of Public Hedth). Southern
Voice is offering a limited number cf reprints of
this article to persons sending in a self-addressed
stamped envelope to PO Box54719, Atlanta,
Georgia 30308. The article can be viewed as a
primer to persons interested in discussing
experimenld drugs with their physicians. As
dways, no one should ever take any drug without
first consulting and being monitored by their
physician.
Franklin Abbott, L.C.S.W. Jane DeMore, R.N., M.N., C.S.
Martha Lou Brock, L.C.S.W. Elaine Mueller, R.N., Ms.T.
Ansley Therapy Associates
Suite 120 • 1904 Monroe Drive • Atlanta, Georgia 30324
(404) 874-8294
BILL GOLDEN
(404) 875-5400 • 377-9205
MEMBER OF
FIRST AND
METRO LISTING
SERVICES
965 VIRGINIA AVENUE. NE
ATLANTA. GEORGIA 30306