AN OVERVIEW OF FIAR
The treatment of HIV/AIDS has advanced considerably over the 21 years of the pandemic. However, there is no cure for HIV disease. Access to antiretroviral therapy (ARV) is severely restricted and for many, remains completely unavailable. For those who have access to ARV, there are numerous problems, most notably with the development of resistance (where the drugs are no longer effective in controlling viral load) and the development of serious, debilitating and sometimes fatal side effects. Therefore, to the extent possible, other interventions with potential value in managing HIV disease, ARV side effects and other sequelae and symptoms must be investigated where there is a reasonable basis for doing so.

The Foundation for Integrative AIDS Research (FIAR) addresses those needs. Normally, one thinks of universities, companies and government agencies of the National Institutes of Health (NIH) coordinating and conducting clinical studies. Still, many important questions that affect the lives of people living with HIV/AIDS and hepatitis C remain unanswered. As the American Foundation for AIDS Research (AmFAR) and other organizations have filled the gap left by the NIH in the investigation of many pharmaceutical drugs along with providing information on those interventions, FIAR will endeavor to fill some of the gaps on interventions that have received less attention, even though they are in widespread use.

Specifically, these interventions are defined by the Food and Drug Administration (FDA) as dietary supplements. These include ingested substances that are not considered foods or drugs. The types of substances include vitamins, minerals, fatty acids, single or mixed amino acids, protein supplements (powders and drinks) and herbs used other than for culinary purposes.

Of course, treatment is not limited to consumed items. Other interventions include body work, acupuncture, exercise, energy work, intercession at a distance and other approaches. Where such a modality is commonly used and represents an important clinical question that must be addressed, FIAR will endeavor to raise funds and coordinate a methodologically sound clinical study.

Selecting Studies:

FIAR's selection of clinical questions to be addressed is drawn first from the infected and affected community. Such a grassroots based approach generates the questions that will help to enhance a sense of cooperation and comradeship between people living with disease and caretakers, practitioners and specialists. This aspect helps to encourage mutual respect rather than authoritarianism. On an economic level, less expensive interventions that show benefit may help to alleviate cost burdens to national healthcare systems while providing tools for arguing for the expansion of state Medicaid formularies to assure access for those who could not otherwise afford such interventions. By contrast, studies that show little benefit will also provide important information to help guide treatment choices and what are very often out-of-pocket expenses.

Product Evaluation:
Funding is also sought to test products selected for clinical evaluation. In order to make study results practically useful, it will be important to canvass commonly available products to assess their potency and purity.

For example, the amino acid N-acetylcysteine (NAC) is in widespread use by people living with HIV. The market has available many different brands. Independent clinical laboratories will be provided samples to evaluate products to establish their purity: whether it contains any common contaminants (mold, yeast, bacteria, heavy metals). Based on funding availability, a sample from two or three batches from selected companies would be evaluated. Organizaions such as ConsumerLab are also consulted.

Then the substance would be evaluated for its potency. In the case of NAC, it is a relatively simple matter to evaluate whether the one constituent is indeed the reduced form of the amino acid. Unscrupulous vendors may sell products which contain very little of the advertised substance. However, even reliable vendors may have product that has deteriorated in quality (for example, NAC tends to oxidize). An acceptable range for some oxidation will be determined.


Cypripedium-tibeticum

In the case of herbs, the procedure is similar, but the difficulty in evaluating potency is somewhat enhanced. Many herbs have a "signature" of a certain compounds, identifiable by high-performance liquid chromatography (HPLC) and other assays. Others are standardized to a specific chemical (e.g., silymarin compounds in milk thistle, Silybum marianum).

Disseminating Information:
FIAR provides background information on proposed study interventions. Once clinical studies have been completed, FIAR will arrange for the statistical analysis of study results and seek to have those data published in peer-reviewed journals. Information will also be disseminated through established AIDS newsletters and as well as on the FIAR web site.

FIAR, a 501(c)(3) not-for-profit, does not accept pharmaceutical or nutriceutical industry funding and relies upon your generosity to continue its efforts.

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