AIDS TREATMENT NEWS #376, December 28, 2001
phone 800-TREAT-1-2, or 215-546-3776

CONTENTS

** HIV Resistance: Data and Spin
National press stories largely misinterpreted the new study
which found high levels of HIV drug resistance in U.S.
patients.

** Barcelona Conference Abstract, Scholarship Deadlines
Early 2002
Online abstract submissions for the XIV International AIDS
conference in Barcelona (July 7-12, 2002) need to be
received by January 21 (note time zones); deadline is
January 14 for paper or disk abstract submissions to be
received. Scholarship applications are due February 1.

** African-Americans and AIDS Conference, February 25-26,
Washington
Nationally prominent speakers will address this year's
conference.

** AIDS TREATMENT NEWS Denialist Series
During the last year and a half AIDS TREATMENT NEWS has
published a series of articles answering fringe theories
(that HIV is harmless, HIV doesn't exist, people should not
be tested for HIV or take antiretrovirals if positive,
etc.) Here are the references and links to all the articles
in our series.

** Medical Marijuana Grants: Application Deadlines January
15, May 1, and September 1
The Marijuana Policy Project announced grants up to $50,000
for projects on law reform, especially medical marijuana.

** Buyers' Club List, December 2001
Our annual list of AIDS-related buyers' clubs and contact
information.

** AIDS TREATMENT NEWS Index, 2001
Annual index of this year's articles


***** HIV Resistance: Data and Spin

John S. James

On December 18 the first report was presented from a new
study of the prevalence of drug-resistant HIV in U.S.
patients in early 1999.(1) This study found that somewhere
between 50 and 78 percent of these patients (depending on
how you count patients whose viral resistance could not be
measured) had some degree of reduced susceptibility to at
least one antiretroviral. White, gay, middle class, insured
patients had the most resistance, on the average, while
those with less access to care had less. The national press
eagerly picked up that story; and when we got home from the
ICAAC conference in Chicago where the preliminary report
was presented, we found that people all over the country
had heard it -- and little else from the conference.

A closer look shows that while the study results are valid
(though not as surprising as they might appear), the
central messages that carried the press story appear to be
misinterpretations -- ones that could have future
consequences for society's political will to deal with the
HIV epidemic, both in the U.S. and abroad:

1. The main message that went out through the press is that
drugs are not working because of resistance. In fact, as
one of the researchers noted to AIDS TREATMENT NEWS, the
good news is that treatments are still saving lives despite
viral drug resistance. And most of the press ignored the
fact, brought out at a press conference at ICAAC, that many
of the patients found to have resistant virus started
antiretrovirals years ago with inadequate regimens, and
added new drugs one at a time as they became available in
the 1990s -- conditions that facilitate resistance
development. Patients starting treatment today do not use
drugs that way.

2. The publicly available abstract of the study, as well as
statements to the press, correctly reported that resistance
was associated with markers of access to care. (Those with
good access to medical care usually started treatment
earlier, and therefore had more time to develop resistance
-- and also they often started with the suboptimal two-drug
or one-drug regimens.) But the emotional subtext that sold
the newspapers was the implication that gay white men,
despite all their advantages, were not doing their part to
control the epidemic.

How the Study Was Done

This resistance study used samples collected in a major
national survey of HIV care in the U.S., the HCSUS study
(HIV Cost and Services Utilization Study).(2) The
importance of HCSUS is that while most studies describe the
particular patients who are available for the researchers
(through a particular medical institution or clinical
trial, for example), HCSUS carefully selected a sample to
be as representative as possible of all HIV-positive
persons receiving medical care in the U.S. (except in the
military, in prison, or in a hospital emergency
department), in the first two months of 1996. HCSUS
randomly selected 4042 patients and interviewed 76% of
them. It found that in January and February of 1996, about
230,000 HIV-infected adults received medical care.(2) HCSUS
also found that "the patient population was
disproportionately male, black, and poor," that many
Americans with HIV were receiving care less than twice a
year, and that the total cost of medical care for Americans
with HIV was less than 1% of all direct personal health
expenditures.(2)

In the new resistance study, over 1900 plasma samples
obtained from HCSUS volunteers about three years later (in
late 1998 to early 1999) were analyzed using the ViroLogic
PhenoSense resistance test. Sixty-three percent of these
samples had a viral load of over 500 copies of HIV, and 89%
of those had resistance test results (those with a viral
load lower than 500 cannot be tested for resistance with
standard tests). Of those who could be tested, 78% had
reduced susceptibility to at least one antiretroviral.

There was confusion in news reports over whether resistance
was found in 78% of the patients, or in about half of them.
This is because the most conservative calculation assumed
no resistance in any of the patients who could not be
tested for resistance. Therefore, 78% (of those
successfully tested who were found to be resistant to at
least one antiretroviral) times 63% (of those eligible for
resistance testing since they had a viral load of over 500
copies), gives 49% of the total study population in which
reduced susceptibility to at least one antiretroviral was
documented. (This calculation is approximate, because in
the actual study weighting factors were used to make the
sample of patients studied be more representative of the
U.S. HIV patient population.) Those who could not be tested
probably tended to have less resistance than the others
(since most had a low viral load, indicating the drugs were
probably working well), but certainly persons with viral
load under 500 can have drug-resistant virus.

This study did not collect adherence information except for
self-reports, and does not have enough data to look at
adherence.

AIDS TREATMENT NEWS talked with Dr. Nick Hellmann of
Virologic, one of the authors of the resistance report. He
noted that despite this viral resistance, the death rate in
the U.S. has still been kept relatively low since modern
combination treatment was introduced. He suspects that part
of the reason is that unlike bacteria, HIV usually pays a
significant price for drug resistance, and is likely to
become less able to replicate and cause rapid worsening of
disease. He noted that while it might be possible for HIV
to evolve to be both highly resistant and highly
pathogenic, this appears to be uncommon.

Comment

This study did indeed find more resistance (HIV with
reduced susceptibility to antiretrovirals) than expected.
But much of this result is not really surprising given the
study design. The patients selected were all in care in the
U.S. in early 1996, but had their blood drawn and virus
tested three years later in late 1998 to early 1999. With
this sampling, many of the patients would have been on
antiretrovirals for a long time, giving more time for
resistance to occur. Since all were in care in early 1996
and known at that time to have HIV, it is likely that many
of them started on suboptimal therapies. This selection
(plus the fact that resistance was tested for many drugs,
and just one positive test led to the volunteer being
counted as having resistant virus) may partly explain why
this study found much more resistance than other studies.

The groups that started treatment earlier -- including gay
men, and those with insurance -- had more resistance,
probably because they had more time for it to develop (as
well as more chance of having been exposed to the two-drug
or one-drug antiretroviral regimens no longer in use).

Could the new publicity on high prevalence of resistance
contribute to the arguments against providing
antiretroviral treatment in Africa? This study only looked
at the U.S. But it is reasonable to assume that if
treatment is introduced correctly in African countries, the
results of this U.S. study would not apply. There will be
less resistance than in the U.S., if patients are started
on modern regimens and managed correctly.

Also, the kinds of HIV that are not native to the U.S. (but
have been common for years in Africa and other parts of the
world) have not spread here to any large extent. Quite
likely the major reason is those at risk of HIV in the U.S.
are far more likely to get infected by a native virus,
which probably blocks infection by other HIV strains. So
the media image of resistant "superviruses" spreading from
Africa throughout the world is contrary to the facts
observed for years.

The right message to take from this study is that viral
resistance is a serious problem, and people should be more
careful to use antiretrovirals correctly. It is also
important to prevent transmission of resistant virus to
persons who are HIV-negative. For those already infected,
generally it is best to have HIV fully suppressed whenever
antiretrovirals are used, so that there is little or no
viral replication, and resistant virus cannot evolve. But
for many patients this goal is not feasible. For these
patients and for everyone else with HIV, we need new drugs
that are more effective, less toxic, and less susceptible
to viral resistance. We especially need new classes of
treatments, including new targets for antiretrovirals, and
immune-based therapies to help the body itself control HIV.

References

1. Richman DD, Bozzette S, Morton S, Chien S, Wrin T,
Dawson K, and Hellmann N. The prevalence of antiretroviral
drug resistance in the U.S. 41st International Conference
on Antimicrobial Agents and Chemotherapy, Chicago, December
18 [abstract LB-17].

2. Bozzettee SA, Berry SH, Duan N, Richman D and others.
The care of HIV-infected adults in the United States. THE
NEW ENGLAND JOURNAL OF MEDICINE. December 24, 1998; volume
339, number 26, pages 1897-1904.


*****Barcelona Conference Abstract, Scholarship Deadlines
Early 2002

The following deadlines are rapidly approaching for the XIV
International AIDS Conference, Barcelona, Spain, July 7-12,
2002:

* January 14: Abstract submissions if by paper or disk;

* January 21: Abstract submissions online
(http://www.aids2002.com);

* February 1: Scholarship applications.

See http://www.aids2002.com for application forms and more
information.


***** African-Americans and AIDS Conference, February 25-
26, Washington

The 2002 National Conference on African-Americans and AIDS
will be held at the DC Renaissance Hotel in Washington,
D.C.

Speakers include:

* Kweisi Mfume, president/CEO of The National Association
for the Advancement of Colored People;
* Beny J. Primm, M.D., The Addiction Research and Treatment
Corporation;
* Celia J. Maxwell, M.D., FACP, Howard University;
* Anthony S. Fauci, M.D., National Institutes of Health;
* Valerie Stone, M.D., Brown University;
* Phill Wilson, African-American HIV/AIDS Policy Training
Institute;
* Robert Fullilove, Ph.D., Columbia University
* Glenn Treisman, M.D., Ph.D., Johns Hopkins University.

"This Conference is designed for clinicians who care for
African-American patients infected with HIV/AIDS, nurses,
pharmacists, HIV/AIDS service organization professionals,
social workers, healthcare media, legislators, and other
allied health professionals concerned about HIV/AIDS in
African-Americans."

This year the conference must charge a $50 admission fee,
which includes breakfast and lunch. There are some
scholarships for people with HIV. Up to 15 hours of
Category 1 CME credit will be available.

For more information, including a full list of speakers,
see http://www.ncaaa.net


***** AIDS TREATMENT NEWS Denialist Series

In our last issue we completed our series of articles,
mostly by Bruce Mirken, answering the "AIDS denialist"
assertions that HIV is harmless (or does not exist), HIV
treatment should be avoided, HIV-related medical tests are
inaccurate and useless, etc. Here we have collected the
references and links to our articles so that the whole
series can be found more easily.

The first article in this series appeared in April 2000,
and the last article in December 2001. The first two
articles below are deliberately out of sequence, so that
our summary of what the series is about can be listed
first. The series actually began in the issue before the
summary.

As we stated in the summary, "Our concern is not the ideas-
-we agree that all sorts of ideas should be explored and
debated--but rather the direct translation of casual
speculation and debating points into the medical care of
patients with life-threatening illness."

The series:

"AIDS Denialists: How to Respond," by John S. James,
AIDS TREATMENT NEWS #342, May 5, 2000
http://www.aids.org/immunet/atn.nsf/page/a-342-10

"Answering the AIDS Denialists: CD4 (T-Cell) Counts, and
Viral Load," by Bruce Mirken, AIDS TREATMENT NEWS #341
http://www.aids.org/immunet/atn.nsf/page/a-341-02

"AIDS Treatment Improves Survival: Answering the 'AIDS
Denialists,' by Bruce Mirken, AIDS TREATMENT NEWS #350
http://www.aids.org/immunet/atn.nsf/page/i-350

"HIV Treatment and Survival: Easy Language Version," by
Bruce Mirken, AIDS TREATMENT NEWS #354
http://www.aids.org/immunet/atn.nsf/page/a-354-08
(This flyer shortens and simplifies the survival article in
issue #350. Agencies can reproduce it as an easy-to-read
backgrounder for clients.)

"Answering the AIDS Denialists: Is AIDS Real?," by Bruce
Mirken, AIDS TREATMENT NEWS #356
http://www.aids.org/immunet/atn.nsf/page/a-356-06

"Viral Load and T-Cell (CD4) Counts: Why They Matter," by
Bruce Mirken, AIDS TREATMENT NEWS #364
http://www.aids.org/immunet/atn.nsf/page/a-364-09
(Easy language version of the CD4 and viral load article in
issue #341, above.)

"HIV Testing 101 (Part 1 of 2)," by Bruce Mirken,
AIDS TREATMENT NEWS #374
http://www.aids.org/immunet/atn.nsf/page/a-374-05

"HIV Testing 101 (Part 2 of 2)," by Bruce Mirken,
AIDS TREATMENT NEWS #375
http://www.aids.org/immunet/atn.nsf/page/a-375-04

The following articles are not part of the same series, but
are related:

"Treatment Interruption: Experts Sound Cautious Note at San
Francisco Forum; Meeting Proceeds Despite Disruption," by
Bruce Mirken, AIDS TREATMENT NEWS #341
http://www.aids.org/immunet/atn.nsf/page/a-341-01
(This meeting on treatment interruption was invaded by
about a dozen AIDS denialists, resulting in minor injury to
a member of the staff of Project Inform, the meeting
organizer.)

"Durban Declaration on HIV and AIDS,"
AIDS TREATMENT NEWS #346
http://www.aids.org/immunet/atn.nsf/page/a-346-03

"Africa: Interview with South African High Court Justice
Edwin Cameron," by Bruce Mirken, AIDS TREATMENT NEWS #368
http://www.aids.org/immunet/atn.nsf/page/a-368-03


***** Medical Marijuana Grants: Application Deadlines
January 15, May 1, and September 1

On January 3 the Marijuana Policy Project in Washington
D.C. announced that grants up to $50,000 will be awarded to
"organizations and projects that articulate effective
tactics and strategies to regulate marijuana similarly to
alcohol and to make marijuana available for medical use.
Grants will not be awarded to hemp-related projects, state
ballot initiatives, or political campaigns." (But a major
focus will be changing marijuana laws in specific
jurisdictions -- especially passing medical marijuana bills
in Maryland, New Mexico, and Vermont.)

The deadline for the first round of grant submissions is
January 15, 2002, and the first round checks will be issued
by March 31, 2002. For those who miss the January 15
deadline, the deadlines for the next rounds are scheduled
for May 1 and September 1.

For more information and instructions for applying, see
http://www.mpp.org/grants/index.html Or contact the grants
department of the Marijuana Policy Project, 202-462-5747
ext. 270.


***** Buyers' Club List, December 2001

AIDS TREATMENT NEWS publishes a buyers' club list each
December. For a short overview and introduction to the
meaning, history, and services of these organizations, see
AIDS TREATMENT NEWS #309, December 18, 1998.

We focus on buyers' clubs specializing in HIV (we also
included Rainbow Grocery in San Francisco, because of its
extensive selection of supplements and excellent
information about them). All the organizations listed below
are nonprofit. Most can provide products by mail order.
Most have fact sheets or other information, and some have a
nutritionist or other expert available at certain times to
answer questions. Some offer financial assistance with
purchases if necessary. Most are open to the public, but
some require membership (which may require an annual fee,
or be restricted geographically or in other ways). Call
ahead for current information.

We have not listed medical marijuana buyers' clubs here.
The best way to find out about any in your area is by
referral from a local AIDS service organization, support
group, or healthcare professional.

Arizona

Being Alive Buyers' Club
http://www.apaz.org/ (click "Buyer's Club")
edgarr@...
1427 North Third St., Phoenix AZ 85004
602-253-2437, fax: 602-253-5577



Travis Wright Memorial Buyers' Club
Southern Arizona AIDS Foundation Buyers' Club
http://www.saaf.org/BChome.htm
info@...
375 S. Euclid Ave, Tucson AZ 85719
800-771-9054 or 520-628-7223
fax: 520-628-7222; TTY: 800/367-8937

California

Rainbow Grocery Cooperative (20% PWA discount, with the
Helping Hand card)
http://www.rainbowgrocery.org/ (no products online 12/01)
vitamins@...
1745 Folsom St., San Francisco CA 94103
415-863-0620

Colorado

Denver Buyers' Club (PWA Coalition Colorado)
1290 Williams St., Suite 102
Mailing address: P.O. Box 300339, Denver CO 80203-0339
303-329-9379, fax: 303-329-9381, pwacolo@...
www.pwacoalitionofcolorado.com (starting Feb. 2002)
Bilingual Spanish/English TTY: thru operator

District of Columbia

Carl Vogel Center
http://www.carlvogelcenter.org
cvc@...
1012 14th St. NW, Suite 707, Washington DC 20005
202-638-0750, fax: 202-638-0749
Membership: annual cost $25 (includes a BIA test, reduced
prices for massage acupuncture, educational symposium,
newsletter, reduced prices for supplements).

Georgia

AIDS Treatment Initiatives
http://www.aidstreatment.org
info@...
159 Ralph McGill Blvd. NE Suite 510, Atlanta GA 30308-3311
888-874-4845 or 404-659-2437
fax: 404-659-2438

Massachusetts

Treatment Information Network's/Boston Buyers' Club
http://www.vitatime.com/
bosbuyrclb@...
Boston Living Center, 29 Stanhope St., 3rd Floor
Boston MA 02116
800-435-5586, or 617-266-2223
fax: 617-450-9412

New York

DAAIR (Direct Access Alternative Information Resources)
http://www.daair.org
email: info@...
31 East 30th St. #2A, New York NY 10016
888-951-5433 or 212-725-6994
fax: 212-689-6471
Note: The largest buyers' club. Membership by sliding
scale, $5, $10, or $25 per year; new members receive
treatment information pack. Also, "Preventing and Managing
Side Effects and HIV Symptoms" is available at
http://www.daair.org (no membership required -- click the
Countering Toxicities button on the home page), or by mail
by request if necessary.

Texas

Houston Buyers' Club
http://www.houstonbuyersclub.com/
hbc@...
3400 Montrose Blvd. #605, Houston TX 77006
800-350-2392
713-520-5288, fax: 713-521-7419
Note: HOW TO MANAGE SIDE EFFECTS, a 48-page booklet by Lark
Lands, Michael Mooney, Nelson Vergel, and others is
available without charge. You can request a copy by phone,
mail, or email.


***** AIDS TREATMENT NEWS Index, 2001

20th year of AIDS 364
911 371
Abacavir 373
Access, international (see Global epidemic)
ACT UP Philadelphia 367
ADAP program 366
ADAP program 371
Africa (see also South Africa)
Africa -- home care 361
Africa 359
Africa 360
Africa 363
Africa 371
Africa 372
Africa 373
African American conference 376
African Americans 359
Agenerase 373
AIDS research -- 20 views 368
AIDS Treatment Activist Coalition 370
AIDSWatch 362
AmFAR HIV/AIDS TREATMENT DIRECTORY 363
AmFAR TREATMENT INSIDER 362
Amprenavir 373
Antibodies and HIV 365
Antibody testing 374
Antibody testing 375
Antiretrovirals list 372
ATAC 370
Barcelona (see International AIDS Conference)
Bioterrorism--immune research 373
Bone disease 366
Brazil 359
Bristol-Myers Squibb 361
Buenos Aires conference 368
Buenos Aires conference 369
Burkina Faso 363
Busch, Barry 367
Buyers' club list 376
Cameron, Justice Edwin 368
CD4 count 364
Civil society 365
Cohen, Jon 367
Coinfection (HIV and HCV) 371
Conference reports on Web 373
Counterfeit drugs 365
d4T+ddI 358
Denialists 364
Denialists 374
Denialists 375
Denialists, AIDS TREATMENT NEWS series 376
Developing countries (see Access, international)
Direct action 364
Doctors Without Borders (see MSF)
Doha 371
Drug donations 361
Efavirenz 362
Efavirenz 373
European parliament 363
Fact sheets 358
FDA 362
FDA 369
Fibrosis 370
Funding -- international (see Global epidemic)
Garlic 375
GB virus C 372
Gilead Sciences (see Tenofovir)
GlaxoSmithKline 360
GlaxoSmithKline 371
GlaxoSmithKline 372
Global epidemic 362
Global epidemic 363
Global epidemic 367
Global epidemic 369
Global epidemic 370
Global epidemic 372
Global epidemic 373
Guidelines 361
Heart disease 370
Hepatitis C 359
Hepatitis C 371
Hepatitis 375
HIV drugs 372
HIV incidence 359
HIV prevention 364
HIV resistance 368
HIV testing, part I of II 374
HIV testing, part II of II 375
Homocysteine 370
IAPAC 369
IAS Conference 368
IAS Conference 369
ICAAC conference 375
ICAAC conference 376
Immune-based treatment 360
Innate immune system 373
Intellectual property -- patent proposal 366
Intellectual property (see also Global epidemic)
Intellectual property 359
Intellectual property 360
Intellectual property 363
Intellectual property 371
Interaction, garlic & saquinavir 375
Intermittent treatment 375
International (see Global epidemic)
International AIDS Candlelight Memorial 364
International AIDS Conference 372
International AIDS Conference 376
Johns Hopkins Report 361
Kaletra 362
Kaletra 373
Liver (see Hepatitis)
Liver fibrosis 370
Malawi 371
Marijuana Policy Project 376
Maternal infant transmission 364
Maternal transmission lawsuit 374
Medical marijuana 376
Medscape 369
Merck 361
Merck 367
Mirken, Bruce 376
Mitochondrial toxicity 366
MSF 361
Names reporting 367
NATAF 370
Nevirapine 358
Nevirapine 374
New Mexico AIDS InfoNet 358
North American AIDS Treatment Action Forum 370
Pediatric AIDS 374
Pharmacokinetics 375
Pipeline (HIV drugs) 372
Post-exposure prophylaxis 358
Pregnancy 358
Protease inhibitors 370
Protease inhibitors 375
Research -- 20 views 368
Resistance conference 368
Resistance prevalence 376
Resistance tests 374
Retroviruses conference 2001 359
Retroviruses conference 2001 361
Retroviruses conference 2002 372
Richman, Douglas 376
Salvage therapy 362
San Francisco 359
Saquinavir 373
Saquinavir 375
Scondras, David 371
Social organization 367
South Africa 359
South Africa 360
South Africa 361
South Africa 364
South Africa 368
South Africa 374
STI (structured treatment interruption) 369
Structured intermittent therapy 375
Sustiva 362
Sustiva 373
Syringe prescription 364
T-20 373
TAC (Treatment Action Campaign) 374
TAG (Treatment Action Group) 364
TAG (Treatment Action Group) 369
T-cell (CD4) count 364
Tenofovir 360
Tenofovir 364
Tenofovir 370
Tenofovir 372
Tenofovir approved 373
Therapeutic drug monitoring 363
Trade rules 371
Treatment access 359
Treatment guidelines (see Guidelines) 361
Treatment interruption 369
Treatment vs. prevention controversy 362
Treatment vs. prevention controversy 365
Tuberculosis guidelines 371
Twinning organizations 363
UNGASS 359
UNGASS 365
UNGASS 366
UNGASS 367
United Nations (see UNGASS)
Vaccines 359
Vaccines 367
Viral load 6-day changes 374
Viral load 364
Viramune 374
ViroLogic 376
Women, treatment 368
Women, treatment 372
World AIDS Day 373
Ziagen 373

***** AIDS TREATMENT NEWS

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