International AIDS Society Newsletter, no. 16

IAS
INTERNATIONAL
SOCIETY

ties for minorities, and we will continue to
assure the participation of minority subjects in
AIDS clinical trials as well as in natural history,
epidemiologic, and prevention studies.
Priority: Better Therapies
The development of highly active antiretroviral
therapy (HAART) has had a significant impact
on the length and quality of life for many HIVinfected people in the U.S. and other developed
countries. However, at the recent January 2000
Retrovirus Meeting in San Francisco, the overriding theme was a long and serious list of problems for patients receiving these HIV therapies, including: 1) failure to obtain a satisfactory
reduction in viral load even for patients who
comply with treatment regimens; 2) expensive
and complicated regimens that make compliance difficult; 3) drug toxicities, including
metabolic complications and diabetes; and 4)
drug resistance.
It is critical that we develop and test new, simpler, less toxic, and cheaper anti-HIV drugs. To
accomplish that goal, we must develop new targets for the design of new antiviral drugs. We
must conduct clinical trials to answer key questions such as: At what point in the disease process should therapy be initiated and which
combination of drugs should be used? At what
point should the drugs be switched and to
which drugs? How can toxicities and drug
resistance be prevented? How can regimens be
simplified and compliance improved? Most
importantly, we must translate research results
into clinical practice information that is useful
to caregivers and their patients.
Priority: HIV Prevention Research
NIH supports a comprehensive approach to
HIV prevention research that includes contributions from the biomedical, behavioral, and
social sciences. The OAR prevention science
research agenda targets interventions to both
infected and uninfected at-risk individuals to
reduce HIV transmission, and recognizes that
different strategies must be applied to each subepidemic in the U.S. and around the world.
Our biomedical prevention research priorities
include areas such as the development of topical microbicides for women; perinatal prevention strategies, including understanding of breastfeeding risk; and management of sexually
transmitted diseases that enhance risk of HIV
transmission. NIH also supports behavioral
research strategies, including prevention interventions related to drug and alcohol use. In
addition to interventions targeting HIV-infected individuals who may not know their HIV
status, we are focusing interventions on HIV
infected individuals who are successfully

responding to therapy. Data suggest that some
of these individuals may re-engage in risky
behaviors because they believe that they are less
infectious or that they cannot be reinfected.
Priority: Vaccines
The critical missing element in our armamentarium is a safe and effective vaccine. In 1997,
President Clinton issued a challenge to the
nation to develop an AIDS vaccine. Consistent
with this challenge, NIH has moved forward
aggressively to build a comprehensive vaccine
research enterprise. OAR has doubled the NIH
investment in HIV vaccine research in the past
four years, and in the current fiscal year we
anticipate spending approximately $240 million in this critical research area. These funds
will provide new grants to foster innovative
HIV vaccine research and allow the invigoration and reorganization of the NIH vaccine clinical trials effort. The new Dale and Betty
Bumpers Vaccine Research Center will be occupied this summer. Dr. David Baltimore continues to chair the AIDS Vaccine Research Committee, which advises the NIH on the overall
vaccine program.
In February 1999, NIH-supported investigators
initiated the first AIDS vaccine trial in Africa.
In collaboration with industry partners, NIH
has now tested 28 different HIV vaccine candidates, individually or in combinations, in over
3,300 uninfected volunteers. Several new vaccines, including vaccines designed to induce
mucosal immunity, novel DNA vaccines, and
more complex vaccines presenting several viral
proteins, have entered phase I trials. In addition, recent studies of therapeutic vaccines that
do not prevent infection, but can prevent or
delay disease progression in animal models
have offered opportunities for additional vaccine strategies.

Benefits to Other Disease Research
AIDS research is unravelling the mysteries surrounding many other infectious, malignant,
neurologic, autoimmune and metabolic diseases. AIDS research has provided an entirely
new paradigm for drug design and development to treat viral infections. The drug known
as 3TC, developed to treat AIDS, is now the
most effective therapy for chronic hepatitis B
infection. Drugs developed to prevent and treat
AIDS-associated opportunistic infections also
provide benefit to patients undergoing cancer
chemotherapy or receiving anti-transplant
rejection therapy. AIDS is also providing new
understanding of the relationship between
immunity and cancer.
The transmissible nature of HIV - between
individuals and across borders and populations
- makes it radically different from non-transmissible diseases such as heart disease and cancer. There is the potential for unlimited spread,
and also the possibility for a dramatic reduction
in new infections - and thus ultimate control of
the pandemic - in a way that can never be possible for noninfectious diseases. The impact of
an intervention that reduces the probability of
transmission, breaking the link in the epidemic
chain, extends far beyond the treated or protected individual.
We have made enormous strides in our fight
against this terrible scourge, but these have
been only small skirmishes in a major global
war. Our progress will be meaningless unless
we can make the benefits of our research findings available to populations desperately in
need, both in our own country and around the
world. The worldwide human and economic
toll of this insidious disease is profound, and we
will never solve the problem of AIDS for our
own citizens without controlling the global epidemic. In our fight against AIDS, we cannot
leave anyone behind.

A Tribute to Neal Nathanson
Mark A. Wainberg and Lars O. Kallings
Neal Nathanson is only 73 years old. But, for the last two years he has worked tirelessly as Director of the Office of AIDS Research (OAR) at NIH and has brought to the position a sense of
renewed vitality and commitment. Thus, many of us were saddened to learn of Neal's imminent
retirement from the position to return to work at the University of Pennsylvania on a full-time
basis.
In fairness, Neal's family also has the right to see more of him than they have for the last 24
months. However, scientists in the field and the many friends that he has made will miss him
enormously. For example, Neal played a pivotal role in garnering support for the recently held
Microbicides 2000 Conference (see Meeting report in this issue) and in nurturing it through to
its successful conclusion. He has also been an unswerving supporter of the International Conferences on AIDS, and fully endorsed the decision to hold the upcoming Conference in Durban.
He will be difficult to replace and we all wish him well in his future endeavours.
U