AIDS Research at the NIH: A Critical Review

* New extramural programs toalling $2.9M for 15 grants and contracts to improve the early detection
of HIV related clinical manifestations; to improve management of HIV-related oral lesions; and to
further determine the role of salivary constituents in inhibiting HIV infectivity.
* New intramural programs totalling $1.43M for virus-host interactions involving infected T cells; role
of HIV genes in Kaposi's sarcoma; neuropathology; nephropathy; and new antiretroviral therapies
using cell surface antigens to target infected cells without damaging uninfected tissue.
Recommendations:
* Congress should replace the $2M taken from NIDR's AIDS budget by President Bush.
* NIDR should expand its studies of monocytes to include tissue macrophages and other mucosal
antigen-presenting cells (e.g., langerhans/dendritic cells), elucidating the mechanisms of cytokine
induction, defective antigen presentation, and immune dysfunction seen in HIV infection and AIDS -
possibly in collaboration with NIAMS, NIDDK, etc.
* Support extramural studies of other oropharyngeal manifestations of HIV, including possibly
autoimmune phenomena such as Sjogren's-like syndrome and the unusual salivary or lacrimal
gland lymphomas associated with the diffuse infiltrative lymphocytosis syndrome (DILS).
* Develop animal models for oral/genital retroviral transmission.
* NIDR should initiate new studies of mucosal immunity to HIV, HSV, CMV, and EBV (comparing oral
immunity to genital, pulmonary, gastrointestinal)...
* Studies of the etiology, diagnosis and treatment of (AIDS and ddC-induced) oral and esophageal
aphthous ulcers (stomatitis) in PWHIV, including studies of thalidomide.
11/V10. National Institute of Diabetes + Digestive + KIdney Disorders (NIDDK)
NIDDK began in 1950 as the National Institute of Arthritis and Metabolic Diseases (NIAMD) and was
originally chartered to investigate rheumatic diseases, diabetes and other metabolic, endocrine and
gastrointestinal illnesses. In 1972, it became the National Institute of Arthritis, Metabolism and Digestive
Diseases (NIAMDD); in 1981, the National Institute of Arthritis, Diabetes, and Digestive and Kidney
Diseases (NIADDK); and finally, in 1986, NIDDK, when its Division of Arthritis, Musculoskeletal and Skin
Diseases spun off to form NIAMS. NIDDK's Division of Intramural Research supports investigations of a
wide variety of diseases, including diabetes, other inbomrn errors of metabolism, endocrine disorders, mineral
metabolism, digestive diseases, nutrition, urology and renal disease, and hematology.
NIDDK spent $6.3 million for AIDS research in 1991. It asked for $10M more next year, and the President
offered $500,000. NIDDK's AIDS work focuses on immunology ($5.2M in FY 1991) and preclinical drug
development ($1 million), funding a range of studies of endocrine, metabolic, gastrointestinal, renal, urologic
and hematological complications of HIV and AIDS. The wasting syndrome receives more attention from
the NIDDK than from any other ICD (which isn't saying much). NIDDK also conducts and supports studies
on basic mechanisms of HIV infection, the structure of HIV and the development of antiviral therapies.
In FY 1991, NIDDK funded 33 research project grants, all R01s, at a cost of $5M. All grants were
classified as immunology. Since 1987, NIDDK issued 6 AIDS RFAs for 1) Pathogenesis of Intestinal
Dysfunction in AIDS; 2) Effects of HIV Infection on the Kidney and in Dialysis and Renal Transplant
Patients; 3) Genitourinary Tract Manifestations of HIV; 4) Pathobiology of Bone Marrow Suppression in
AIDS and ARC; 5) Endocrine Aspects of AIDS; 6) Endocrine Basis of Wasting in AIDS

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