AIDS TREATMENT NEWS No. 059 - July 1, 1988
John S. James

Reporters faced a huge mass of information with no organizing principle, and no help in deciding what was important other than following the "conventional wisdom" of what was in style among physicians and scientists. No single treatment or small group of them compelled special interest based on actual data presented at Stockholm--although chances are good that a number of treatments discussed may prove very important in the future. But for now, even from the mass of reports taken together, no pattern emerged.

Mainstream reporters complained that you could take any angle you wanted at this conference, and support it. As one commented, you could shoot anywhere and hit something. This excessive freedom makes the reporter's job more difficult, because no guidance emergences from the material itself. Reporters do not want their basic relationship to the story to be arbitrary.

In this situation we owe the reader some explanation of our own biases and approach, as we begin a series of several articles on dozens of specific treatment possibilities about which information was presented in Stockholm.

First, we have not considered treatments unless we saw some thread of possible usefulness in the foreseeable future. But many of the potential treatments we report are not ready for people to use now, and some will never be.

We considered selecting what to report from the point of view of what information is most useful now, but decided against this approach for several reasons. First, hundreds of practicing physicians attended the conference, and they are in the best position to know what is immediately important. We can interview them about this information, and plan to do so.

Second, no one can know at this time which treatment leads presented at Stockholm will turn out to be important. The more suggestive, unproven developments are the ones most likely to be overlooked by the conference attenders; often in the history of science and medicine valuable information is lost for years in this way. We want to make this information available to those who did not happen to attend the conference and read a particular poster.

The remaining question is how to make coherent to our readers a massive body of facts which fits no particular pattern, no particular categories. We expect to organize each article as a guided tour, using particular treatments to illustrate concepts or viewpoints which may help in understanding the overall picture of AIDS research. We cannot organize the articles in advance, however, as it will take us several weeks to go through the material, as we are writing about it; and in any case we have not found useful ways to categorize the treatments. Each article will consist of what emerges at that time from material not covered so far.

HOE/BAY 964 (Poster #3656)

We never heard of this substance before, and conference attenders could easily have missed it, as no mention appeared in the published book of abstracts (abstracts submitted months in advance, therefore lacking the most current information). Instead, HOE/BAY 964 appeared only at the conference itself, at the end of a poster ostensibly about something else. The poster, titled "Development Of HIV-Variants With Higher Resistance Against AZT Under Treatment With AZT", was presented by seven German scientists from two research institutions in West Germany, and one from the Karolinska Institute in Sweden. What caught our attention was the statement that this substance is already in clinical study in Germany; therefore we thought we should know about it.

The poster primarily reports on a study of what may be a reason that the effectiveness of AZT often falls off after long-term use--development of drug resistance by HIV.

Other reports have suggested that evolution of HIV within each patient may be an important part of the natural history of disease. HIV evolves far faster than other viruses or organisms, and the development of drug resistance may occur independently within each person. It is certainly conceivable that due to prevention methods such as safer sex--which patients will probably have adapted well before their diagnosis and treatment with AZT--the resistant virus would be unlikely to spread to others, and therefore the cumulative development of resistant strains may not be a problem. (This possibility reinforces the advice that persons who are HIV positive or who have AIDS must avoid unsafe sex with each other.)

The poster (#3656) included a summary, the first two paragraphs of which were identical to the published abstract (except for updating the number of persons known to have developed AIDS from 64,000 when the poster was submitted to 84,000 when the conference took place). The researchers followed 60 AIDS patients receiving AZT for periods up to one year, and during this time AZT did not reduce the ability to culture virus from the patients' blood.

Three of the 60 patients were studied more intensively by testing the susceptibility of their virus to AZT in the laboratory. The researchers found that the virus from these patients was significantly less sensitive to AZT late during the course of the treatment, meaning that drug resistance had developed.

Then the summary included the following apparently new results, introducing HOE/BAY 946 almost as an afterthought:

"In contrast, HOE/BAY 964 (chemically a xylan(hydrogensulfate) disodium salt), an inhibitor of HIV currently under clinical investigation in Germany, did not show significant differences in the inhibition of the RT from sequential virus isolates from these patients." The poster also included a diagram with the chemical structure of HOE/BAY 964, and clinical results from the three patients whose virus was studied.

We could not be sure from the poster that HOE/BAY 964 had been tested in humans. But as this issue went to press, we heard from a physician who talked to the researchers who presented the poster (#3656). They told him that they are using HOE/BAY 964 with patients, especially those who need to discontinue use of AZT. (Therefore it seems especially important to investigate this this new antiviral now, as many people have been using AZT for about a year, and may need to find another treatment soon if the AZT becomes less effective due to development of drug resistance by HIV.)

AmFAR (the American Foundation For AIDS Research) is following up on HOE/BAY 964 for possible inclusion in the new issue of its treatment directory. AmFAR is in an excellent position to collect this kind of information, since it is a well-known, respected organization, and it gives several million dollars a year in research grants. We will continue to report on this treatment possibility as more information becomes available.

Note On Treatments:

More readers have asked us questions about dextran sulfate and AL 721 than about any other experimental treatments. We will cover these later when we have time to assemble the information. Briefly, both dextran sulfate and AL 721 had some new information presented at Stockholm, but nothing spectacular. Perhaps the biggest news was the great interest in dextran sulfate among physicians and scientists at the conference. Only a little new human data was available, however.

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