Gay Men's Health Crisis: Treatment Issues, Volume 7 no. 10 - November, 1993
David Gold

A Public Health Service Task Force on Prophylaxis and Therapy for Mycobacterium Avium Complex (MAC) recommends that HIV- infected individuals with less than 100 CD4 cells receive 300mg per day of rifabutin (Mycobutin, Adria Labs) as MAC prophylaxis. If MAC develops, the task force recommends a multi-drug treatment regimen, which includes either clarithromycin or azithromycin. The Task Force states that physicians have added one or more of the following drugs as "second, third or fourth agents: clofazimine, rifampin, rifabutin, ciprofloxacin, and in certain cases, amikacin."

Isoniazid (INH) and pyrazinamide, commonly used anti- tuberculous drugs, are not effective for MAC. Diagnosis, prevention and therapy for HIV-infected children under thirteen years should follow the same guidelines. The full recommendations appear in the The New England Journal of Medicine. (September 16, 1993, 329:828-833).

Help Wanted at NIH

Efforts to fill two critically important AIDS research positions at the National Institutes of Health (NIH) are underway. A search committee has been appointed to recommend Director of the Office of AIDS Research (OAR). This position is dramatically enhanced by passage of the NIH Revitalization Act of 1993 (S1/HR4). The committee was charged with conducting an active recruitment process. Members of the Search Committee include Art Amman (Pediatric AIDS Foundation), Derek Hodel (AIDS Action Council), Peggy Hamburg (formerly NYC Commissioner of Health), Kristine Gebbie (White House "AIDS czar"). Of some concern, the committee contains not less than nine members who currently hold positions within the NIH. The final decision on the OAR Director will be made by HHS Secretary Donna Shalala in early 1994. A search for the position of Director of the Division of AIDS (DAIDS) in NIAID is also underway. NIAID, whose Director is Tony Fauci, presently accounts for the bulk of federal AIDS research spending. The search committee for the DAIDS position is composed entirely of government people without any community representation. Among those believed to be under consideration are: Acting Director, Jack Killen; CPCRA head Lawrence "Bopper" Deyton; acting Associate Director Margaret Johnston; and the head of the Army's AIDS research program, Donald Burke, who may also be under consideration for the OAR position. Killen, Deyton, and Johnston are all considered responsive to community concerns. Burke is considered a "no-nonsense guy" but he may have been hurt by the gp160 controversy and, more importantly, is considered by some to be more committed to preventive HIV vaccine research than treatment research. What many believe is needed is an outsider who can institute changes in the DAIDS research program. Nevertheless, it is unclear whether Tony Fauci, who will make the ultimate decision on the DAIDS Director, can, or even wants to attract, a credible, well-respected outsider to fill the position.

Megace Approved

Megace Oral Suspension (Megestrol acetate) has been approved by the FDA for anorexia, cachexia or unexplained significant weight loss in PWAs. Manufactured by Bristol Myers Squibb, a New York-based drug company, the drug is a derivative of progesterone, a hormone used to correct abnormalities of the menstrual cycle. In two twelve-week studies, people with AIDS with wasting syndrome who were given 400 to 800mg of Megace demonstrated a five to seven pound weight gain compared to placebo. However, there was also a trend, though not to statistically significant levels, toward higher mortality rates among patients given the drug. In addition, impotence developed in some male patients on the drug. Megace is available, free of charge, to all patients who do not have adequate insurance coverage and can not otherwise afford the drug. Call 1-800-788-0123 for information on financial assistance for Megace or ddI, another Bristol Myers product. Call 609/897-2126 for more information about megace.

More on ADAP

The New York State Department of Health offers a number of programs that are designed to provide HIV-positive individuals with access to health care. These programs are part of the AIDS Drug Assistance Program (ADAP) and cover HIV Drugs, Primary Care and Home Care. New York State residents who are uninsured or underinsured are eligible. Call 1-800- 542-2437 for more information.

NMAC Expands AIDS Treatment Work

The National Minority AIDS Council (NMAC) has initiated the AIDS Treatment and Research Network to facilitate access to treatment information in communities of color. Call Moises Agosto at 202/544-1076 for more information.

New "Living With AIDS" Guide from gmhc

GMHC's revised edition of "Living with AIDS" - a guide of important information and resources for people with HIV - is now available. The book is free to GMHC clients and costs six dollars for others. To order, send a check for six dollars for each copy requested to: Myrtle Graham, GMHC, 129 West 20th St., NY, NY 10011.

Our Treatment Library Needs a New PC

GMHC's AIDS Treatment Library needs a new PC computer to run Medline, a computer database of the world's medical literature. Our Amdek 286 PC is (obviously) very old and does not have enough memory to support adequately the service. While our Medline CD-ROM system was generously donated by CD PLUS in New York and the NIH, they do not supply the computer to run the service. Medline service is available to all Treatment Library users and is used extensively by GMHC staff. Contact Paul Warren at 212/337-3695 to donate or sponsor the purchase of a new computer.

AIDS Newsletter for Children and Parents

JUST KIDS is a newsletter covering medical and social issues faced by HIV-infected children, teens and their parents. Yearly subscriptions are ten dollars for individuals, twenty dollars for professionals and institutions, and $30 for international orders. The newsletter is provided on a sliding scale or free upon written request. Send subscription requests to JUST KIDS, c/o 3 Corners, Inc. P.O. Box 42, Village Station, New York, NY 10014. Write checks or money orders to 3 Corners, Inc. All donations are tax-deductible.
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Copyright © 1993 - Treatment Issues. Reproduced with permission. Treatment Issues is published twelve times yearly by GMHC, Inc. All rights reserved. Noncommercial reproduction is encouraged. Subscription lists are kept confidential. GMHC Treatment Issues, The Tisch Building, 119 West 24th Street, New York, NY 10011  fredg@gmhc.org  http://www.gmhc.org

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