PWA Health Group: Notes from the Underground #26

NOTES FROM THE UNDERGROUND
The PWA Health Group Newsletter
"Access to Information Precedes Access to Treatment"
May/June, 1994 Issue 26

Introduction

Openly Underground

Drug Descriptions

This is a special issue of NOTES FROM THE UNDERGROUND, covering each of the products that we're carrying today, a sort of blue plate special.

Since it's June '94, and time to recognize some of the more dramatic moments of lesbian and gay history, I'd like to suggest saluting the heroes of the AIDS drug underground, who for years with great imagination, courage, and sterling perseverance have brought you promising HIV/AIDS therapies through, shall we say, a variety of venues.

These heroes are all of you who recognized that the system just didn't give a damn and went out and did the work yourselves: learning medical practice and research language, tariff regulations and drug quality control standards, and how to sit on government committees, testify before Congress and not sweat through customs. Not only that, you learned how to talk to each other about what the government, medical and research communities, pharmaceutical and health food industries alike have never thought was your place: your own health and how to fight for your life.

In organizing buyers' clubs, setting up PWA hotlines and support groups, institutionalizing citizen input into the research process, and taking to the streets to demand change, you turned the American health care system upside down and built a community dedicated to people, to health and to survival, not profit. All Americans have benefitted by your resourceful questioning and years of hard work. Here's to our brave shared history, imagination, grace and outrageous good taste. Happy Lesbian & Gay Pride -- and bravo.

The PWA Health Group: openly underground after all these years

The PWA Health Group is the nation's largest HIV/AIDS buyers' club, offering at cost promising HIV/AIDS treatments. We got started in the spring of 1987 by two PWAs, Michael Callen and Tom Hannan, and their doctor, Joe Sonnabend, in order to provide a safe treatment for AIDS, called egg lipids or AL721. The PWA Health Group has grown in spite of itself, eventually importing most of today's standard-of-care antibiotics, including fluconazole, azithromycin, clarithromycin, and itraconazole, months to years before FDA approval.

Tom and Michael set up shop in a local church, figuring that the police would be reluctant to arrest them there, and held a press conference. The press came, and the police didn't. For seven years now, the press has often come, and the police never. No one associated with the Health Group either as a patient, a patient advocate, or a doctor, has ever been arrested, sued or held liable in any way for accessing our drugs.

In fact, after an ACT UP demo in the spring of 1988, the FDA issued a regulation outlining the right of Americans to import medicines approved abroad for their own personal use. Although sometimes dismissed because the guidelines put in writing how the FDA had long operated, the political imagination of AIDS activists forced into the open FDA practice and opened up access to foreign drug research and development for all Americans.

Buyers' clubs operate under these personal use guidelines, importing modest amounts of promising therapies. Some provide a wide variety of products, a sort of one-stop shopping model. Healing Alternatives, started in 1986, is a sister buyers' club in California, that offers many things, including the cheapest vitamins in the country.

The PWA Health Group is a bit of an oddball: we try to focus on what is not readily available anywhere else. The Board, consisting mostly of PWAs and a handful of AIDS doctors, is admittedly conservative in deciding what genuinely has promise for the treatment of HIV and AIDS. They consider data, safety and cost. Safety can be a wide-ranging topic for the Board, as sometimes PWAs and doctors view it differently. But also, because we are starting to have some sense of what HIV is doing in your body, or HIV pathogenesis, proposed treatments get scrutinized for their possible effects on the course of HIV disease. For example, will a treatment lessen an excessive level of a chemical messenger in PWAs? Could it also speed up some other process of immune system malfunction? We're so cranky that sometimes we require prescriptions for things that no one else in the world does.

Are buyers' clubs legal? Not really. We're here only because of the political pressure you exert to keep us here. It's pretty amazing that we are. There aren't any cancer or Alzheimer's or lupus buyers' clubs to my knowledge, although I wish there were. We could get closed down any time, although given our careful record and lack of secrets, it doesn't seem likely. In fact, sometimes I argue that we're like a community- based FDA: we review treatments, giving them the nod or thumbs down; we test for quality; and we issue fact sheets, or labels, for each thing we distribute. We go one step further, of course, because we operate as a nonprofit, and our financial records are open.

Designed to jog the system and show it what it could and should be doing, seven years later the PWA Health Group is still here because of the appalling lack of imaginative AIDS drug development, and the political wisdom of PWAs still fighting to survive. And we're going to continue to show the system what it could be doing if this country really gave a damn, as long as we need to be, until surviving AIDS is everyone's reality.

We welcome suggestions, questions, comments, volunteers, writers, and your company, any time.

Drug Descriptions

Albendazole
Albendazole is used to treat microsporidiosis, an increasingly common infection that can affect any part of the body, but most often causes severe diarrhea. There are no approved treatments in the US. Albendazole has been studied in several open label trials, the results of which mirror clinical experience: a moderate percentage of PWAs respond well, but not everybody. It's available free from SmithKline Beecham with proof of diagnosis: 800/877- 7074 (physicians only), or from us with a prescription.

Approved in Europe and most Third World countries, albendazole is another relatively cheap drug held back because the parent drug company (SmithKline) doesn't feel that the market size is big enough to justify further expense. In light of the hundreds of PWAs buying this drug from us, this negligence is appalling. Large studies are needed now to better understand this infection, proper dosing regimens and to get the drug approved so that it's fairly available to all PWAs.

Furthermore, albendazole may have other uses, eg., test tube and limited clinical evidence suggest that it may be stronger than Flagyl for treating giardia. The Health Group provides SmithKline Beecham's albendazole, brand name Zental, in boxes of 6 x 200 mg tablets [prescription required].

Azithromycin
Azithromycin is an approved macrolide antibiotic used for treating MAI/MAC, cryptosporidiosis, gonorrhea, urinary tract infections and chlamydia. Use for toxoplasmosis has not been so promising. The Health Group began importing it months before FDA approval and has continued to carry it solely because it's such a bargain abroad.

It's best to take azithromycin on an empty stomach and wait a couple of hours after antacids or drugs with antacids, such as ddI, as absorption is best in an acidic environment. The Health Group carries Pfizer brand name Zithromax from Germany in boxes of 6 x 250 mg [prescription required].

DHEA
DHEA is a naturally occurring adrenal hormone in men and women that is often low in male PWAs. DHEA is not well understood, but is critical to testosterone and cortisol release and to the production of testosterone. A 1991 retrospective study found an increased risk for progression to AIDS in men with 200-499 T cells and low DHEA. Recent in vitro results suggest that DHEA may be a potent enhancer of IL-2 and may have direct anti-HIV effects in T cells and macrophages. An earlier small European study found no direct anti-viral effect as measured by p24). A recent SFCA study found DHEA to be well-tolerated, with no serious toxicities. No anti-viral effect was seen, although absorption complications may have played a key role: PWAs with better absorption had more of an increase in CD4 counts.

DHEA is a relatively popular drug. PWAs report feeling better, and having significantly more energy. Although larger controlled studies with PWAs have been run in Europe, the results have yet to be published (which is not exactly a hopeful sign - the company is mum). As a result, we don't know how useful DHEA replacement therapy is for HIV, or if it is, what dose would be best.

As it may increase facial hair or lower one's voice, DHEA has not been studied in women with HIV/AIDS. DHEA is low in women to begin with, but the lack of study is further disturbing, because depressed levels of DHEA have been associated with increased risk for breast and ovarian cancer.

A note of caution: DHEA has been studied and abundantly promoted for years now, particularly as an anti-aging drug. The Health Group requires a prescription because if DHEA up-regulates IL-2, it may indirectly stimulate HIV. The Health Group provides pharmaceutical grade DHEA, analyzed for potency and purity [prescription required].

Hypericin/St. John's Wort
Hypericin, derived from a medicinal herb called St. John's Wort, has shown anti-HIV and anti-CMV activity in the test tube. St. John's Wort has been safely used by PWAs for years. Activated by light, in sufficient doses hypericin can cause a photo-toxic reaction: sunburn, rash and severe itching. This toxicity delayed completion of an ACTG study of intravenous synthetic hypericin. Furthermore, levels of hypericin in the blood from the iv formula dropped too fast to see if it had an anti-viral effect in people.

A recent open-label trial using intravenous herbal hypericin reported that 14 of 16 PWAs had stable or increased T cells and no progression to AIDS during the 40 months of the trial. There are currently clinical trials enrolling using synthetic hypericin (now in an oral form) for genital warts (HPV) and HIV.

Buyers clubs' and health food stores sell herbal formulas (pills) containing mild amounts of hypericin and pseudo-hypericin. Without clinical studies, we have no way of knowing the right dose to have an anti-viral effect or how useful it really is. We have been unable to confirm the consistency and quantity of hypericin in these products, even the more expensive ones. Nevertheless, many PWAs feel that hypericin helps stabilize their immune system, boosts their energy, and may keep their CMV in check. The Health Group currently provides two herbal formulas: Pacific Biologics' HY10 (15 x 10 mg pills) and Yerba Prima's St. John's Wort (180 tablets).

Isoprinosine
Isoprinosine, known for its anti-allergic properties, has been studied since the mid-80's for its immuno-stimulating qualities. A raft of somewhat promising and somewhat discouraging test tube and clinical studies leave us with no clear answers: does it increase natural killer cells, gamma interferon, IL-2, and a variety of cellular functions? In the test tube, yes, in some small studies of PWAs, yes and no. Two large clinical trials showed little anti-HIV effect or any increase in T cells, but another large study (n=866) showed a significant decrease in progression to AIDS.

Since then, isoprinosine has been associated with a decreased risk for PCP, possibly because one of its ingredients interferes with the same pathway by which sulfa-based drugs work against PCP (as per in vitro work by the NCI). Also studied for herpes in comparison trials with acyclovir, acyclovir has been consistently superior, although in one study, a combo of both worked better than either. Isoprinosine has shown efficacy treating children (not HIV-positive) with molluscum. Well-tolerated, isoprinosine has been used by some PWAs for years now, who feel it's critical to stabilizing their immune system. The Health Group provides isoprinosine from Mexico, produced by Roussel in boxes of 20 x 500 mg pills.

Itraconazole
Itraconazole is an approved triazole antifungal, used for thrush, histoplasmosis, aspergillosis, cryptococcal meningitis, fingernail and hair infections, leishmaniasis, etc. Carried by the Health Group prior to FDA approval, it's another medication that we carry simply because it's so much cheaper abroad.

In comparison with ketaconazole, itraconazole appears to be better tolerated, with less liver toxicity and no adrenal suppression, and somewhat greater activity against aspergillus. Fluconazole remains the first line treatment choice for most fungal infections as it stays active longer in the body and is readily absorbed into cerebral spinal fluid. A note of interest: itraconazole has recently shown anti-microsporidiosis activity in vitro.

If you're taking antacids, or drugs with antacids, such as ddI, you should wait a couple of hours before taking itraconazole, since it needs an acidic environment to get absorbed into your body. Also, taking it with fatty foods will increase absorption.

Ketotifen
Ketotifen is a non-toxic anti-allergy drug used all over the world to treat asthma. Although its use in asthma is somewhat dubious, ketotifen's primary side effects of weight gain and increased appetite may be promising for PWAs. Two small pilot studies reported last year indicated that ketotifen lowers TNF-alpha, increases body cell mass and increases weight in PWAs. Ketotifen also protects cells in the lining of the stomach and the colon, and is being studied as a treatment for colitis/inflammatory gut disease, which has a lot in common with HIV-related colitis.

There have yet to be any controlled trials with PWAs, so we do not know how efficacious it is, or what's the best dose to take. It has been safely studied in children as well as adults, and a number of case studies suggest that ketotifen may be helpful in treating acne and swelling (edema) around sores. The Health Group imports Sandoz Pharmaceuticals ketotifen, brand name Zaditen, from France, in boxes of 60 x 1 mg pills.

Levamisole
Levamisole, originally developed to de-worm livestock, showed immune modulating activity in mice almost thirty years ago. Since that time, it has been used in a wide variety of diseases, but not always with positive results. It has not shown any benefit as a treatment for AIDS. A Dutch open label study in 34 patients with AIDS reported that levamisole treatment produced no effects whatsoever.

Nevertheless, levamisole may help treat certain conditions such as apthous ulcers and genital warts. Levamisole has serious side effects. In people without HIV, levamisole has been shown to cause flu-like symptoms, skin rashes, mouth ulcers, fevers, very low white blood cell counts that could be fatal, insomnia, headache, nausea, etc. The Dutch study notes that 38% of the PWAs experienced side effects. The Health Group imports Decaris brand levamisole in boxes of 2 x 50 mg tablets [prescription required].

Memantine
In Germany, memantine is used to treat Parkinson's, dementia in the elderly and to speed the recovery of comatose patients. We've recently made it available as a possible treatment for HIV encephalopathy, based on the clinical experience of a handful of neurologists who have been using it with PWAs and extensive test tube data. The animal and in vitro data suggest that memantine may help PWAs with HIV-related neurological problems, such as memory loss, confusion, and trouble with speaking, walking, or concentrating. Does it? We don't know, as there haven't been any controlled clinical trials with PWAs.

Merz, who owns this drug, is not interested in developing it. A promising sister drug, nimodipine, which may work well in concert with memantine, did get into ACTG neuro trials. It costs about $1000/month in the US. Since nimodipine may cost as little as a 1/5 of that abroad, maybe we'll pick it up if the trial results are good.

We require a prescription, as there are potentially serious toxicities and drug interactions to be careful about, and the data in PWAs is limited. Some doctors use memantine prophylactically, but questions about efficacy, absorption, optimal dose and dosing regimens remain open. The Health Group imports Merz memantine, brand name Akatinol, in boxes of 50 x 10 mg tablets [prescription required].

NAC
NAC (N-acetylcysteine) is an amino acid used for years by PWAs to pump up intracellular glutathione (GSH), a cell chemical involved in most metabolic processes and often low in PWAs. Cells die without GSH. NAC is one of a variety of nutrients often used by PWAs as anti-oxidants to help the immune system. NAC may also lower TNF-alpha, a chemical often elevated in PWAs, that stimulates HIV and may be related to weight loss. Finally, NAC may help alleviate sulfa-based antibiotic allergies (eg., Bactrim/Septra).

Although NAC is blessed with more theory for its use than most anti-retrovirals, we still don't know what dose to take, whether it's properly absorbed in PWAs, and if it has any anti-viral effect. Maybe the lack of systematic study is because it can't be patented, so no big bucks for some corporate bank account. There's an increasing number of studies of its patented cousin, procysteine, but maybe that's coincidence. On-going NAC studies: a Canadian trial looking at its effect on Bactrim/Septra allergies, and German and Californian studies on absorption.

NAC is one of our most popular products, has very few side effects and is usually taken at doses used in clinical trials: @600-2400 mg/day. The Health Group carries two pharmaceutical brands of NAC, effervescent made by Elan in Switzerland, 10 x 800 mg, and capsules from Zambon in Italy, 30 x 200 mg.

Oral Amphotericin B
Oral amphotericin B has been approved for decades in Europe as treatment and prophylaxis for a number of oral and GI fungal infections, including thrush. This form of amphotericin B comes in a much smaller dosage than the intravenous kind, eg., the usual dose for oral thrush is 400 mg/day. No side effects have been noted with this drug with doses under 3000 mg/day. An American study for fluconazole resistant thrush is planned for later this year.

This low-dose oral form of amphotericin B does not get absorbed by the body, and can't be used to treat infections outside of the GI tract. Although ketoconazole and fluconazole are commonly available for thrush, we carry oral ampho B as an alternative for resistant strains of thrush. The Health Group carries liquid (12 ml x 100 mg) and lozenges (56 x 100 mg), made in England by Squibb [prescription required].

Pentamidine
Approved for PCP prophylaxis, pentamidine is carried by the Health Group because it is so much cheaper abroad. Available since the mid-70's, the American price of pentamidine took off with its approval for PCP prophylaxis. As a result, the Health Group began to import it from Yugoslavia at a significantly cheaper rate, in order to embarrass the company into lowering its price.

Pentamidine is also somewhat famous as the first antibiotic approved for AIDS. Fought for by activist PWAs whose doctors had been using for it years based on data from transplant patients, pentamidine was approved in 1989. Note: off-label use of antibiotics remains the cornerstone of good patient care in AIDS: Bactrim was finally approved for PCP prophylaxis this past winter.

The Health Group imports Rhone Poulenc's pentamidine 1 x 300 mg [prescription required].

Peptide T
Peptide T, a nasal spray used for peripheral neuropathy and early stages of dementia, is by far the most popular treatment we offer. A chain of 8 amino acids, peptide T was developed to mimic HIV's outer gp120 protein and interfere with HIV replication. It has never been shown to have any anti-viral effect. A 1992-93 phase II study of severe peripheral neuropathy showed no difference between those on placebo and those on peptide T: about 30% of both felt better. There have also been a couple of small promising studies for psoriasis.

Currently the two tiny drug companies sharing the license are sitting tight, waiting for Sept '95 results of a neuro-cognitive trial, typical of the tedious pace of development that has accompanied this drug for years. Dogged by limited research, corporate greed, ambitious researchers and conservative patent holders (the National Institutes of Mental Health, part of the NIH), peptide T could be a case study in how not to develop a drug. There are no clinical trials currently open for peptide T, although the ACTG Neurology Committee is presently seeking sites for an HIV-related dementia trial.

The anecdotal experience of hundreds of PWAs shows it to be a safe, well-tolerated drug. Some PWAs with neuropathy respond dramatically and others do not respond at all. Similarly, for some PWAs experiencing memory loss, confusion and orientation problems, the improvement is striking. And, as in both clinical trials, PWAs report an increase in energy, appetite, weight stabilization and overall sense of well-being. Peptide T is quite expensive and is produced under sterile conditions for the PWA Health Group.

Ribavirin
An underground HIV/AIDS drug for many years now, ribavirin got it's initial boost from the extravagant anti-viral claims of its manufacturer, ICN Pharmaceuticals. Large clinical trials in PWAs have showed no benefit over placebo, and one combination trial with isoprinosine actually showed a decrease in all kinds of white blood cells, including CD4s. One study showed it negates the activity of AZT, but another indicated that it enhanced the activity of ddI. An on-going follow-up study with ddI has suffered from poor enrollment.

Since then, an NIH study of ribavirin as a treatment for hepatitis C has put it back on the map. Hepatitis C can be a particularly virulent form of hepatitis, and is far more common among all population groups than previously suspected (for years it was classified as a disease shared mostly by injection drug users, and thus languished with little study or research dollars). In one small Serbian study, ribavirin was also useful against hepatitis A.

ICN is a small company, but further research on ribavirin has been stalled by more than just the usual lack of resources: the president of ICN, Milan Panic, took a nine month leave of absence to become prime minister of Yugoslavia, and since then the company has been sued by a corporate raider shareholder who's also part of the BCI scandal. Many PWAs have taken ribavirin for years, and much like isoprinosine, feel that it has been integral to maintaining a stable immune system. The Health Group imports ribavirin in boxes of 12 x 400 mg tablets.

SSKT
An ancient Asian herbal preparation of seven different plants, Sho-saiko-to in Japanese, or Xiao Chai Hu Tang in Chinese, SSKT is the number one herbal product in Japan. It has shown anti-HIV (anti-reverse transcriptase) and immuno-modulating activity in the test tube, including reducing prostaglandin E2 (possibly involved in cell apoptosis), IL-6 and TNF-alpha; upping IL-1; enhancing the killing ability of macrophages (phagocytosis); and increasing polyclonal antibodies. Used in Japan and China for chronic kidney, liver and gastro-intestinal problems, it is currently being studied in Japan for hepatitis and is in phase II trials as an anti-epileptic. Plans to run clinical trials for HIV in the US have languished.

There have been no clinical trials with PWAs, so we do not know how useful it is, what dose to take, or even whether PWAs can absorb enough orally to have any of the effects seen in the test tube. Many PWAs have taken it for years and it seems to be very safe. We sell the Sun Ten brand, in bottles of 120 tablets.

Sulfadiazine
A first-line cheap treatment choice for toxoplasmosis, sulfadiazine has been out of stock in America since December 1993. It's available for free from the CDC: 404/488-4928 (physicians only) or from us. The FDA has no idea when it will be back in drug stores, but two generic drug companies have applied for INDs.

Toxo treatment consists of two phases: a high-dose acute phase, and a lower dose lifetime maintenance phase. Sulfadiazine is usually given with pyrimethamine and leucovorin (to protect against pyrimethamine bone marrow toxicities). As a sulfa antibiotic, it often causes allergic reactions (rash, fever, leukopenia) but many PWAs have successfully de-sensitized themselves. We have copies of a de-sensitization protocol. It's worth considering, as the usual alternative, clindamycin with pyrimethamine, is very expensive and can cause severe c. difficile diarrhea. We currently import sulfadiazine from Germany made by Heyl in bottles of 80 x 500 mg pills [prescription required].

Tinidazole
Tinidazole is a widely-approved, safer alternative to Flagyl, used to treat whatever Flagyl is commonly used for, including giardia, amoebas, vaginitis, PID, trichomonas, etc. Approved in most European countries and Australia, several studies have shown comparable efficacy to Flagyl, plus superior absorption and twice the half life in the body.

Considerably gentler than Flagyl, tinidazole is usually taken as a single dose for giardia or trichomonas, and for only 3-5 days for amoebas.

Issues: there have been no studies using tinidazole in PWAs, so we don't know whether a longer dose is indicated. Clinical experience from PWAs and their doctors has been quite favorable. Also, there is some preliminary evidence of its use against microsporidiosis. Why is this drug not available in the US? Pfizer has decided the market isn't big enough to justify the studies the FDA would require. The Health Group imports Pfizer's tinidazole, brand name Fasigyn, from Mexico, in boxes of 8 x 500 mg pills [prescription required].

Coming in July:

Saccharomyces boulardii (SAC)
SAC (as we're calling it) is a yeast sold over the counter in Europe to treat diarrhea and particularly C. difficile-related diarrhea (an infection that can occur after anti-biotics kill all the gut's natural flora and fauna). We're importing it because of anecdotal reports and one small study that reported very good results for hard to treat diarrhea in PWAs.

Although SAC is non-toxic, there is a potential danger that, as a yeast, it could get out of control in PWAs, and start systemic infections the way candida does. Anti-fungal drugs can eradicate it. There are also cheaper health food store brands. We plan to import the pharmaceutical grade SAC because we are unsure of the health food store product quality control.

Under development

Curcumin: A derivative of the spice turmeric that inhibits HIV in the test tube by blocking the long terminal repeat (LTR) portion of HIV's DNA and making the virus latent. Recently, Search Alliance ran a open label study of curcumin in PWAs.

Dirithromycin: Apparently this new macrolide (approved in Spain) has shown some activity against cryptosporidium in animal models at high doses. But maybe too high for human use.

Fumigillin: Has shown activity against microsporidiosis in vitro and in two case studies.

Glycyrrhizin: This licorice extract is approved in Japan for liver diseases. It has also shown some anti-HIV activity. We plan to import it shortly from Japan.

Irinotecan (CPT-11): This cancer drug inhibits HIV in the test tube the same way curcumin does, but it is much more potent. This drug has serious side effects but would be used at much lower doses in PWAs.

LEM: A lentinus extract that has shown anti-HIV activity.

Nimodipine: Nimodipine is approved in the US to improve the neurologic condition of patients after sub-arachnoid hemorrhages. We're interested in it for HIV encephalopathy. So is the ACTG -- they recently finished a study.
The question is, does the drug have a positive effect? We hope to hear some study results soon.
Oxandrin: Oxandrin is an oral anabolic steroid being studied for growth disorders in children, HIV wasting, and as a treatment for alcoholic hepatitis. It is much less liver toxic than other oral anabolics. We're waiting for results from phase II studies.

Tat Gene Inhibitor: The tat gene inhibitor, which in an ACTG study appeared to be worthless, seemed to work quite well in vitro when used with Trental. Because of this, it is enjoying a resurgence on the underground. A benzodiazepine, it is made on the underground (hopefully not in a bathtub), but we don't know its quality.

Thalidomide: Currently in ACTG trials for apthous ulcers, weight loss and as an anti-HIV drug. There is an FDA sponsored treatment IND for PWAs with apthous ulcers (301) 443-9553. Data showing substantial weight gains in PWAs is expected this summer.

Thymosin Alpha-1: We would like to provide this injectable drug from Italy for people with chronic hepatitis B. One trial showed promise in combination with AZT and alpha interferon as an immune-modulator. But we've had problems getting a hold of it.

Una de gato: A Peruvian healing herb that is being used by PWAs in South America. Some researchers are studying it.

NOTES FROM THE UNDERGROUND is published six times a year by People With AIDS Working for Health, Inc., a non-profit buyer's club doing business as the PWA Health Group, and reports on issues pertaining to underground AIDS treatment and access.

Articles in this publication are for informational purposes only, and in no way constitute an endorsement of any particular treatment regimen or strategy. We do not consider ourselves qualified to offer medical advice, and encourage people to consult with their physician prior to taking any medications.

Index to Notes

copyright 1996 by People With AIDS Working For Health, Inc.
REPRODUCTION IS HEARTILY ENCOURAGED.

Home

PWA Health Group
last modified: 7/2/96

Table of Contents