Treatment Review No. 12; June 1994

IVIG: Treatment Review reported in its last issue that some preparations of IVIG had been withdrawn because of possible hepatitis infections. Baxter, the company that made the withdrawn product, has since been granted approval for distribution of a product that has been cleaned with a solvent detergent, preventing the transmission of hepatitis infection.

Megace: Megace (megesterol acetate), a synthetic hormone, has been approved for the treatment of anorexia, cachexia, and weight loss in people with AIDS. Anorexia is the long-term loss of appetite. Cachexia is a term meaning general ill health and malnutrition due to a chronic disease.

d4T (stavudine): d4T is an antiretroviral similar to AZT, ddI, and ddC. The trade name for d4T is Zerit. It is also known as stavudine. Bristol-Meyers Squibb, the company who makes Zerit, has applied to the FDA for approval of its drug. Studies of d4T continue for the treatment of HIV infection in children, and in combination with AZT or ddI for the treatment of HIV infection in adults. Neuropathy can be a side effect of taking d4T. Other possible side effects are elevated liver function tests. Liver function should be closely monitored if you are taking d4T. The New York Times reported on May 20, 1994 that a panel of scientists recommended the government approve d4T, but with a strong warning that doctors still do not know enough about the drug to say who should take it. The FDA has not said when it will decide on d4T. It is not bound by advisory board decisions, though it generally follows them. Studies of d4T as a treatment for HIV infection are ongoing.

NAC: NAC is a precursor to glutathione, which means that it turns into glutathione in the body. Glutathione is an antioxidant the body produces. People with HIV infection can have low levels of glutathione. NAC may help boost production of glutathione. A small study at Stanford University in California is underway. NAC has been used for decades in Europe as an anti- bronchitis treatment and is considered non-toxic. It is not know what the side effects will be in the high doses used in the Stanford trial.

Mepron (atovaquone): Mepron is a drug that is approved for the treatment of mild PCP pneumonia. The current version of Mepron requires taking the drug in conjunction with a hefty meal that contains a considerable amount of fat. The company that makes the drug (Burroughs Wellcome Co.) is about to ask the FDA for approval of a new liquid suspension that is expected to be more readily absorbed, even without a fat filled meal. In addition, a study about to be reported on suggests that Mepron is effective against microsporidiosis related diarrhea. The use of the drug for this purpose, however, needs much more study. Mepron is available by prescription.

Interleukin-12: A naturally occurring immune system chemical that may help to restore proper functioning of the immune system is now in clinical trials in San Francisco and Los Angeles. This is a Phase I study to test the safety of the drug. Participants only receive one shot of the drug. Each participant will be given a higher dose than the last participant, until the highest tolerated dose is found. If the drug is found to be safe, participants in this Phase I study will be given first pick at other studies of the drug, provided they meet the criteria for those studies.

Zovirax: A study done by a research team in Australia shows that high doses of acyclovir (Zovirax), a drug used to treat herpes infections, can significantly prolong the lives of people with AIDS. The 1992 study indicates that, compared to placebo (study participants were given either a placebo or the drug), acyclovir could lengthen survival time in AIDS patients. Although it is still not known at this time, acyclovir may have an even greater effect on people in the earlier stages of the disease. Scientists are very cautious about making this claim, however, especially in light of the results of recent studies of AZT. Although AZT has been shown to be an effective treatment for people with AIDS, a recent study of the drug did not clearly show that it works as well for people without illness. The Health Department of the Australian government is considering approving acyclovir as a treatment for HIV infection.

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