AIDS Research at the NIH: A Critical Review

11/1.

National Institute of Allergy + Infectious Diseases (NIAID)

In 1902 the Rocky Mountain Laboratory was founded in Hamilton, Montana, to study Rocky Mountain
Fever. In 1948 it merged with the NIH Divisions of Infectious Diseases and of Tropical Medicine into the
National Microbiological Institute (NMI). NMI was renamed NIAID in 1955 (P.L. 81-692). NIAID grew from
a $5 million institute in 1954 to $104M in 1970 and $215M in 1980. Largely because of new AIDS program
funds, NIAID grew from the sixth largest institute in 1981 to the third largest in 1991 (behind only NCI and
NHLBI). NIAID was given specific AIDS responsibilities under the Health Omnibus Programs Extension
["HOPE"] Act of 1988 (P.L. 100-607). NIAID consists of the Division of Intramural Research (see below)
and four extramural divisions, the Division of Extramural Activities (DEA), the Division of Microbiology and
Infectious Diseases (DMID), the Division of Allergy, Immunology and Transplantation (DAIT), and the
Division of AIDS (DAIDS). DMID studies respiratory infections, hepatitis, sexually transmitted diseases,
nosocomial (hospital-associated) infections, mycobacterial diseases, parasitic diseases, enteric diseases,
and bacterial vaccines. DMID administers the Cooperative Antiviral Study Group (CASG), a pre-AIDS
clinical research network, and the Mycoses Study Group (MSG); both are administered by the University
of Alabama at Birmingham. DMID also runs a network of Vaccine Evaluation Units (VEUs), which worked
on the hepatitis and influenza vaccines, and are now working on AIDS vaccines. DMID also administers
a system of large Program Project (P01) grants focused on sexually transmitted diseases at UCSF, Seattle,
North Carolina, and elsewhere. NIAID also runs several international collaborative projects in tropical and
parasitic diseases. DAIT focuses on basic immunology, immunogenetics and transplantation, asthma,
allergic diseases and clinical immunology. It runs a network of 12 Asthma and Allergic Disease Centers
and six Centers for Interdisciplinary Research on Immunologic Diseases (CIRID). DAIDS, which appears
to be restructured every six months, now consists of three programs, the Basic Research & Development
Program (BRDP), the Clinical Research Program (CRP) and the Treatment Research Operations Program
(TROP). Each program has several subordinate branches. The NIAID director at the start of the AIDS
epidemic was Richard Krause, who retired in July 1984. His successor is Anthony S. Fauci, who received
his MD from Cornell in 1964, came to the NIH as a clinical associate in the Laboratory of Clinical
Investigation (LCI) in 1968, became deputy clinical director of NIAID and was named chief of the new
Laboratory of Immunoregulation in 1980. He became NIH Associate Director for AIDS Research in 1988,
as well as Director of the Office of AIDS Research (OAR), which reports directly to the NIH Director. The
AIDS programs of NIAID are different in scale from those of any other NIH institute. NIAID alone spends
53 cents of every NIH AIDS dollar, or $431M of $799M in FY 1991. NIAID's AIDS budget grew by leaps
and bounds in the mid-1980s - to $145M in 1987, $394M in 1990 and $433M in 1991. Huge extramural
programs were solicited, awarded and administered by a tiny corps of in-house staff. This created
nightmarish logistical problems throughout the years of budgetary growth. Now the AIDS budget is flat.
DIVISION OF INTRAMURAL RESEARCH (DIR) Of 15 DIR laboratories, 9 conduct AIDS research. Much
NIAID basic immunology, while not coded as AIDS-related, is obviously crucial in providing a foundation
for elucidating pathogenesis, immune regulation, and potential methods of immune reconstitution. The
Laboratory of Clinical Investigation (LCI), whose chief is Stephen Straus, conducts basic and clinical
studies of systemic mycoses, pathogenic fungi, herpesviruses, and HIV. They are trying to develop a
peptide subunit vaccine for genital herpes (HSV-2) and are studying Epstein-Barr virus (EBV) and chronic
fatigue syndrome, interactions between HIV and HSV, and how EBV immortalizes B cells, sometimes
leading to lymphoma. The Laboratory of Immunogenetics (LIG), whose chief is Thomas Kindt, studies
MHC antigen presentation and is developing a rabbit model of HIV infection. The Laboratory of
Immunopathology (UP), whose chief is Herbert Morse III, works on DNA viruses, murine leukemia
(retro)viruses, MAIDS, oncogenes and hematopoiesis. Morse and co-workers have developed a surprising
approach to treating mouse AIDS (MAIDS), which involves using the immunosuppressive drug Cyclosporin
A (CsA) with or without AZT; the mice thus treated progressed more slowly or did not develop MAIDS at
all. The Laboratory of Immunoregulation (LIR), whose chief is Anthony Fauci, works on T cell and B

14