AIDS Research at the NIH: A Critical Review

increased, where new initiatives are necessary, etc..

* Advisory committees need to stop being rubber stamps. They could take a more hands-on
role in setting research priorities. Although OAR coordinates several advisory committees, none
conduct detailed, ongoing evaluations of existing programs. In addition, they need more diverse
representation from the many communities affected by AIDS.
* NIH should develop performance scores for AIDS grantees, contractors, and intramural
researchers, using objective criteria including peer-reviewed publications, study accrual rates,
program efficiency, and relevance to clinical care.
* OAR should put out an annual "Guide to NIH AIDS Programs" which includes all awards
arranged coherently under the institute, division, branch which administers them, and with subtopics
or keywords accessible by an index or a computer disk.
BASIC RESEARCH + IMMUNOPATHOGENESIS
Basic research on AIDS at the NIH stresses the molecular biology of HIV, its structure, and its life cycle.
This work has expanded our knowledge about the virus and provides a strong foundation for the
development of new antiretroviral therapies and vaccines. However, there is not a commensurate allocation
of resources for the study of the basic immunology of the disease.
The central questions of AIDS pathogenesis remain far from resolution after over a decade of research.
The lack of attention to the immunopathogenesis of the disease, and the response of the host, reflect a
larger problem in basic AIDS research: a general disregard for the physiological in basic research on the
disease and a need to bridge the gap between basic and clinical research.'~ While this may be heresy
to some, pathogenesis research should look to the body for its future course; it needs a physiological and
not simply an in vitro virology-driven foundation. We propose the following:
* Establish an Immunopathogenesis Task Force. NIH needs a central office to evaluate and
guide efforts to elucidate the pathogenesis of AIDS. Such an ITF would evaluate the state of NIH
research in the area; assess new work by US and foreign scientists; determine how NIH should
follow up, confirm or extend compelling work; foster cooperation and collaboration between
research teams intramurally, extramurally, and internationally; maintain an annual list of
unanswered questions on the pathogenesis of the disease; and promote research on these topics
through intramural research or the issuing of RFAs. The task force would include prominent
immunologists, both those working in AIDS and immunologists from outside the field, to provide
a "basic" perspective.
* Increase Support for Basic Research on Wastina Syndrome. NIH needs to increase its financial
support and stop giving lip service to basic research on wasting and other metabolic and GI
conditions.
* Increase Support for Basic Research on Neuroloay. Increase support for studies on the
mechanisms of HIV-associated and drug-induced neuropathology. Interactions between the
nervous, endocrine and immune systems are a virtually ignored area of research.
DRUG DISCOVERY
10 GG, Notes from a meeting with David Ho, MD, Spring 1991.