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r m iJ T m n e w s
A dded to
the
A rsenal
The Food and Drug Adm inistration has approved a new drug that may
replace protease inhibitors in some treatment regimens by Bob Roehr
he Food and Drug Administration
approved a new antiretroviral
treatment Sept. 18.
DuPont Pharmaceuticals will
market efavirenz under the trade
name Sustiva. It is a non-nucleoside reverse
transcriptase inhibitor. Two other drugs in this
class, delavirdine and nevirapine, have been
used for years as part of the therapeutic arsenal
designed to combat HIV.
Sustiva differs from the other two in that it is
taken only once a day, which should facilitate
adherence to an often complex regimen of com­
bination therapy.
People taking anti-HIV cocktails may swal­
low up to 40 pills on a precise schedule through­
out the day. Missing even a few pills allows the
virus to mutate and become more difficult to
treat; increased compliance is therefore an
important goal for patients, physicians and drug-
makers alike.
Sustiva “is really, really important,” says
Spencer Cox, spokesman for the Treatment
Action Group in New York. “It provides the
D epressed ?
G et C hecked
basis for once-a-day therapy that is well tolerat­
ed and seems to be at least as effective as any­
thing out there on the market.”
Cornelius Baker, executive director of the
National Association of People With AIDS,
praised the drug for its much needed once-daily
dosing and tolerance profile that will mean new
treatment options for children.
C ox, meanwhile, says DuPont’s primary
study “demonstrates very nicely how, over a six-
month period, Sustiva can be used to replace
either a protease inhibitor or two nucleoside
analogs in a standard [combination] regimen.”
Still, not all is perfect. Studies show HIV
quickly mutates resistance to Sustiva when the
drug is taken as monotherapy. It should be used
only in combination with at least one other
antiviral drug.
Also, a study of the drug’s effects on monkeys
suggests a possibility of birth defects, so women
of child-bearing years probably should not take
the drug.
Then there’s the issue of cost. A ID S activists
had speculated the drug would be expensive,
Cornelius Baker
“perhaps even in the range of the protease
inhibitors that [it] would supplement or some­
times replace,” according to a consensus state­
R ealizing R isk
Research show s lesbians have higher rate of breast cancer risk factors;
scientists call for further investigations
Oct. 8 is National Depression
Screening Day
H
ate your job? Your lover? Or the lack
thereof? Things aren’t going well with
the family? Whether or not your life sucks,
clinical depression can make it seem that
way.
“Gays and lesbians probably do have
somewhat higher rates of depression,” says
Dr. Jeffrey S. Akman, past president of the
National Lesbian and Gay Health Associa­
tion. He attributes it to the pressures of com­
ing out and internalized homophobia.
Signs of depression may include a sense
of hopelessness, sadness and anxiety. Physi­
cal symptoms include headaches, stomach
problems, difficulty sleeping or sleeping all
of the time, and changes in eating or weight.
While many people grapple with depres­
sion, most never receive treatment.
“A lot of times people aren’t even aware
of the levels of the symptoms they go
through,” says Robert Cabaj, a psychothera­
pist in San Mateo, Calif.
He adds the stress of work or dealing
with an intolerant society “can be a real dis­
guise for chronic depression.”
Oct. 8 is National Depression Screening
Day. More than 100,OCX) people are expect­
ed to take a 10-question screening test, meet
with a mental health professional and, when
necessary, be referred for further evaluation.
The program is free at more than 3,000
sites across the nation. In the Portland area,
screenings will be held at Legacy Emanuel
Hospital (call 335-3500 to preregister), and
Ability Center (call 636-0111 for schedule).
■ Reported by B ob ROEHR
A
re lesbians at higher risk for
breast cancer? The question has
been posed at many gay and les­
bian medical conferences, and
the issue has been explored in
both the mainstream and gay press. But no sci­
entific study had been reported— until now.
According to a Sept. 28 press release from
the Gay and Lesbian Medical
Association, the September issue
of the Journal of the Gay and Les­
bian Medical Association is report­
ing on the first study to compare
breast cancer risk factors in les­
bian and heterosexual women.
Though G LM A says more
research needs to be done, the
results indicate there are indeed
significant differences between
the two groups of women.
The study, “Differences in
Risk Factors for Breast Cancer:
Lesbian
and
Heterosexual
W omen,” was conducted by
researchers Stephanie Roberts,
medical director at Lyon-Martin
Women’s Health Services in San
Francisco, and Suzanne Dibble,
an associate adjunct professor at
the University of California, San
Francisco.
Their study was based on an
analysis of the medical charts of
1,019 women who were treated at Lyon-Martin
between 1995 and 1997. Nearly all of the
women were low-income and lacked health
insurance; about 58 percent identified as hetero­
sexual, while the rest identified as lesbian.
According to G LM A , Roberts and Dibble
found that the lesbians had a higher body mass
index, fewer pregnancies, and more breast biop­
sies— three previously identified risk factors for
breast cancer.
Although cigarette smoking has not been
definitively shown to be a risk factor for breast
cancer, the study did find that the heterosexual
women were more likely to he current smokers.
Regarding risk factors such as family history
of breast cancer, current or past alcohol use, or
having had a mammogram, there were no sig­
nificant differences between the two groups.
In addition, there was no significant differ­
ence in the prevalence of breast cancer between
the two groups: Five cases were identified in the
lesbians, three in the heterosexual women.
ment signed by representatives
from most of the nation’s major
A ID S organizations.
In an effort to keep costs down,
they petitioned DuPont to
price Sustiva “in accordance
with other drugs in its respec­
tive class.”
In a press release, DuPont
officials said Sustiva will cost
$3,942 a year, “in the mid­
range of the antiretroviral
class”— that is, about a $1,000
a year more than the other
non-nucleoside reverse tran­
scriptase inhibitors, but sub­
stantially less than protease
inhibitors.
DuPont officials claimed in
their media statement: “When
used in a triple-combination
therapy, as it was studied, Sus­
tiva will be less expensive than
the current standard of care
including protease inhibitors.”
Sustiva’s main side effects are
dizziness, insomnia, impaired
concentration,
abnormal
dreams and drowsiness. Unlike
those caused by most A ID S drugs, these side
effects usually disappear over time, the FDA
said.
The researchers note, however, that breast
cancer risk increases with age, and that the rel­
atively young age of the women in the study—
the mean age for the lesbian women was 41 and
for the heterosexual women about 44— could
account for this result.
“Our study underscores the need for more
research that compares lesbian and heterosexu­
al women of different ages and economic groups
and from various geographic regions,” says
Roberts. “It’s still too early for us to develop spe­
cific mammography guidelines for lesbians, but
our study shows the importance of encouraging
lesbians to seek medical care on a regular basis.”
Roberts and Dibble, who first presented their
results at G LM A ’s 16th annual meeting held in
late-August in Chicago, are
embarking on a three-year
prospective study of 5,000 les­
bian and heterosexual women
that will he funded hy Califor­
nia’s Breast C ancer Research
In addition, Dibble has
received a grant from GLM A’s
Lesbian Health Fund to study
treatment differences between
lesbian and heterosexual women
who have been diagnosed with
breast cancer.
“For far too long lesbiaas have
had more questions than answers
about their health,” says GLM A
President Kathy Oriel, an assis­
tant professor of family medicine
at the University of Wisconsin.
“The results of this study and of
Roberts and Dibbles’ future
research will play an important
role in providing the long-await­
ed information lesbians need."
G LM A , which is based in San Francisco, is
an organization of 2,000 lesbian, gay, bisexual,
and trans physicians, medical students and their
supporters. Founded in 1981, the group works to
combat homophobia within the medical profes­
sion and in society at large and to promote qual­
ity health care for sexual minorities.