AIDS Research at the NIH: A Critical Review

* $1.2M to study gut-associated lymphoid tissues (GALT) anti-HIV responses;
* $5M for mucosal immunity and transmission studies;
* $630,000 to develop new models for fungal skin infections;
* $800,000 for "basic research to foster strategies for reversal of immune suppression";
* $700,000 to develop models for natural history, diagnosis and disease of microsporidia;
* $177,000 for add-ons to ongoing neuroscience activities;
* $3.8M to double NIAID-funded AIDS training fellowships;
Drug development
* $3M for minority infrastructure clinical trials development;
* $360,000 to screen new anti-HIV agents in the SCID-hu mouse model;
* $90,000 for additional studies of CD4-PE40;
* $500,000 to screen new OI drugs;
* $1.3M to develop anti-HIV gene therapies;
* $1.5M in new funds for targeted OI drug delivery;
* $160,000 to develop intracellular anti-HIV antibodies;
* $500,000 to study viral resistance to anti-HIV drugs;
* $930,000 for ACTG drug supply management;
* $7M in new funds for the CPCRA (for total of $26M);
* $300,000 to support ACTG pharmacology labs;
* $800,000 to support ACTG immunology labs
* $1 M to support reference centers for OI pathogens;
Vaccine development
* $12.5M for SDAC to manage the data from vaccine trials;
* $3M to evaluate AIDS vaccines in chimpanzees;
* $1.6M to develop HIV particle vaccines;
* $1 M to develop vectors to induce mucosal immunity;
Epidemioloav
* $10OM for a new cohort study of women with HIV;
* $13.5M in additional funds to enlarge the WITS study (for total of $20M);
* $5.7M to establish and enlarge the WITS data center (to total $8.7M);
Given the flat funding base, to fund any of these new programs, NIAID will have to cannibalize existing
ones and/or cut the amount of new R01s it awards this year.
Recommendations:
* NIAID, as the lead AIDS institute, is responsible for coordinating the NIH AIDS effort, ensuring that
efforts are not duplicated and orphan areas are not left unstudied, and for carrying out the
substantial recommendations we have listed above and throughout this report.
* Major increases in basic, applied and clinical immunology are required if the promise of immunebased therapy is to be achieved;
* A new focus on small, well designed, precisely focused pathogenesis-directed clinical studies may
be the best focus for DATRI and for much of the early phase ACTG studies in the future;

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