Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.
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The San Francisco Examiner - Wednesday, June 25, 1997
Lisa M. Krieger; Examiner Staff Writer
Similar guidelines were published Tuesday by an international panel of experts in the Journal of the American Medical Association.
Also this week, a team of international researchers said that they had proven, in a trial studying 3,500 people in 22 countries -- the largest of its kind -- that the three-drug combination boosted survival by 50 percent. It is important to not "save" protease inhibitors until patients have advanced disease, but to start three-drug therapy early, the doctors concluded.
But in practical terms, will these recommendations change treatment? Not for everyone, according to the AIDS Drug Assistance Program, or ADAP, Working Group. The group is a Washington, D.C.-based coalition of 32 pharmaceutical companies and activist organizations that monitors the state-run programs, designed to help get new and expensive HIV drugs to the poor. The treatment costs about $12,000 a year.
A recent survey of ADAPs by the working group found that many programs were incapable of making recommended treatments available to all who needed them. Specifically, it found that:
* At least 16 states' ADAPs have taken or expect emergency measures to cut costs in fiscal 1997. Measures include stopping enrollment, restricting access to the drugs, developing more restrictive eligibility and reducing the number of drugs available.
* Four state ADAPs (in Arkansas, Oregon, South Dakota and Nevada) have yet to cover any protease inhibitor.
* At least 10 states -- including Florida, Oklahoma and Alabama, as well as the District of Columbia -- have capped access to protease inhibitors. Mississippi is removing 660 patients from its program.
* Numerous states have, through their ADAPs, developed restrictive medical criteria for access to the drugs, creating rules that violate the federal and international guidelines.
* Only five ADAPs provide therapies to treat AIDS-related opportunistic infections.
Despite such restrictions, the new guidelines are expected to further fuel the number of patients filling prescriptions through the state programs. During the second half of 1996, the number of Americans seeking ADAP help increased by 1,000 people per month, according to the working group.
International guidelines
Updated guidelines for HIV care have been published by an international panel of AIDS experts to advise caregivers and patients as they deal with the ever-changing state of HIV therapy. The recommendations, similar to those released earlier by the federal government, are published in Tuesday's issue of the Journal of the American Medical Association.
The recommendations cover:
* When to initiate therapy. It is recommended for patients who have a viral load greater than 5,000 to 10,000 copies per milliliter of blood. (Previous guidelines recommended therapy for counts above 30,000 to 50,000.)
The panel suggested that therapy should be considered for all HIV-infected patients with detectable HIV who request it and are committed to lifelong adherence to treatment.
* What drugs to start with. The recommended regimen is two nucleoside analogs (for example, AZT/DDI, AZT/DDC, AZT/3TC, 3TC/D4T or D4T/ DDI) and one protease inhibitor.
* When to change therapy. It should be changed if the viral load increases, suggesting treatment failure; if the patient suffers from side effects; or if the patient cannot adhere to the regimen.
* What to change to. If a change is needed, it is recommended to change all drugs in the regimen, or at least two of the drugs. A simpler or substitute regimen might be the solution.
Coverage while working
The state Assembly has passed legislation by Assemblywoman Carole Migden, D-San Francisco, to continue health coverage for people with HIV/ AIDS who are on Medi-Cal and want to return to work but cannot afford to because of the cost of their medications.
The bill, AB 1099, covers disabled people on Medi-Cal and is expected to generate substantial savings for the state as people leave public assistance and become taxpayers.
Events
* Project Inform will hold an introductory town meeting to discuss "Introduction to HIV Treatment Options" on July 2 from 6:30 to 8 p.m. at the Project Inform office, 1965 Market St., Suite 220. Call (415) 558-8669.
* "Reality," a magazine of poetry, testimonials and art is looking for submissions for an upcoming issue. The topic: "The effectiveness of protease inhibitors -- Are they are a miracle cure or not?" Deadline is July 3. Mail to: HIV, 1242 Market St., Third Floor, San Francisco 94102. Or call Robert at (415) 487-5777 ext. 33.
* "HIV Therapy in 1997: The End of AIDS?", a discussion on the promises and problems of new HIV therapies, will be presented by Dr. Steven G. Deeks of UCSF on July 9 from 12:10 to 1 p.m., Room N-225, 513 Parnassus Ave. Free. Call (415) 476-4394.
* The Community Consortium is offering workshops to educate AIDS service providers on developments in HIV treatments, and on how to help clients gain access to promising new therapies.
Three workshops will be offered, in San Francisco on July 11 and 18 at the Mission Center Building from noon to 3 p.m.,and in Oakland this Friday at the Center for AIDS Services from noon to 3 p.m.
The toll
Stephen G. Frugoli, 32, a singer and actor who performed with the S.F. Gay Men's Chorus, S.F. Opera Chorus and Theatre Rhinoceros, and on the first national tour of Les Miserables. In 1989, he won a Bay Area Theatre Critics Award for his performance in the title role of "Candide" with TheatreWorks . . . John G. Keck IV, 39, an auto mechanic who raised more than $500 each year in contributions to the annual Dance-A-Thon and who lost 40 friends to AIDS in the past six years.
Date
reported Cases Deaths
S.F. 6/1 21,698 15,089
Calif. 6/1 100,912 64,832
U.S 6/1 548,102 343,000
WHO(rprtd) 6/1 8,400,000 6,400,000
Figures are cumulative since June 1981. Government officials now compile and release statistics quarterly, not monthly. To contribute to AIDSweek, call
(415) 777-7867. AIDSweek columns are available on the Internet at www.examiner.com/aidsweek/ aidsweek.html
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