ACTG Highlights

Opportunistic Infections Research - National Institute of Allergy and Infectious Diseases
HIV-ASSOCIATED OPPORTUNISTIC INFECTIONS:
NIAID-SUPPORTED CLINICAL RESEARCH
The major NIAID-supported effort directed toward clinical research on HIVassociated opportunistic infections (Ols) is coordinated by the Treatment Research Program
(TRP) of NIAID's Division of AIDS (DAIDS). TRP coordinates two major clinical trials
initiatives, the AIDS Clinical Trials Group (ACTG) and the Community Programs for
Clinical Research on AIDS (CPCRA). ACTG is a collaborative network of 47 university
medical centers across the country that carry out AIDS clinical research. CPCRA, a
community-based clinical research program, currently includes 18 clinical units at the front
line of the AIDS epidemic. At the National Institutes of Health (NIH) campus in
Bethesda, NIAID researchers conduct AIDS clinical research through the Institute's
Division of Intramural Research (DIR). In addition, NIAID's Division of Microbiology and
Infectious Diseases (DMID) supports clinical research on viral and fungal diseases that
occur as HIV-associated Ols through two special programs, the Collaborative Antiviral
Study Group (CASG) and the Mycoses Study Group (MSG).
Clinicians who care for people infected with HIV face a challenging situation.
HIV-associated Ols are rarely curable. At best, they can be controlled during an acute
episode and usually require long-term suppressive therapy. Concurrent or consecutive
infections with different organisms are common, and this can affect the clinical response to
treatment. Moreover, infections associated with HIV are often severe. They commonly
occur in disseminated forms and are characterized by a high density of organisms in the
affected tissues.
Many current therapies for Ols are toxic, or must be given intravenously and thus
are difficult to administer for long periods. Some 01 organisms have or will become
resistant to standard therapies. New and improved agents to treat and prevent most HIVassociated Ols are urgently needed.
Clinical trials of experimental agents pose several difficulties. Potential enrollees
usually have a sudden, acute 0I that must be treated immediately. To ensure that such
patients have the opportunity to enroll in a clinical trial of a promising new agent, the
research center must maintain effective working relationships with primary care and
emergency room physicians and with health care workers of clinics where the patients will
first seek treatment. Round-the-clock staffing by the research team--including physicians,