The Wall Street Journal - 1 August 1996
Michael Waldholz, Staff Reporter of The Wall Street Journal

The coalition will help organize research to determine which of the new drug "cocktails" work best, when should therapy be initiated, and what steps can be taken to avoid the development of widespread drug resistance that could devastate the new therapies' effectiveness.

"The new treatments have a degree of complexity not faced before in AIDS," said Linda Distlerath, a Merck & Co. official who is a member of the organization. She added that the group will try to "facilitate and coordinate" numerous clinical trials in the next few years.

The coalition includes officials from the White House and several government-health agencies, several pharmaceutical companies, research-medical centers, private and government health insurers, and patient-advocacy groups. The representatives came together earlier this year after Vice President Al Gore held an initial meeting with many of the participating organizations.

"This is precisely the kind of dialogue patient-treatment advocates have been asking for years," said David Barr of the Gay Men's Health Crisis, New York. "One thing that's been very frustrating to us over the years is the lack of coordination and conversation among all players."

Under the auspices of the Keystone Center, a Colorado nonprofit group, the officials met privately five times in Washington. On Friday, the group met with Vice President Gore and announced the partnership, to be called the Forum for Collaborative HIV Research.

In recent months, several studies found that combining several new and older drugs can suppress HIV, the AIDS virus, more potently than any treatment before. The new drugs, called protease inhibitors, have been available since earlier this year. But already there is evidence that when used with older drugs, such as AZT, the therapy can make the virus undetectable in the blood of many patients.

This has led to an improvement in patients' besieged immune systems and health. At least two studies suggest the therapies can prolong patient survival. Some researchers say long-term treatment with the drugs may transform AIDS into a manageable chronic disease, and, there is even hope that the drugs may eradicate the virus from some.

But the protease drugs, produced by Merck, Abbott Laboratories and Roche Holding Ltd., are very expensive and cumbersome to use. In all, patients must take about 15 or more pills daily, and skipping the regimen can allow the virus to re-emerge, perhaps in a form that is resistant to all existing medicines.

Moreover, doctors and patients are confused as to how best to combine the medicines. Constance Benson, a research physician at Rush Medical College, Chicago, said she and her colleagues are uncertain because the new drugs were approved quickly, following only limited safety and effectiveness trials.

"We need a more rational way to answer the questions our patients ask us," Dr. Benson said. "They want to know when to go on the therapy, how long they need to take the drugs, which drugs to start with, when can they stop."

Initially, the Forum will encourage several large-scale drug trials to test which of various treatment strategies works best. One already under development will involve several thousand patients and last three to five years. "[The trials] will require an enormous amount of financial resources, the cooperation of many drug companies" and many medical centers and other groups, such as Veterans Administration hospitals, health-maintenance organizations, and state and federal- government insurers, such as Medicaid, Dr. Benson said.

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