AIDS Research at the NIH: A Critical Review

Nutrition + Wasting. Some grantees are investigating diagnosis, etiology and treatment of HIV-related
nutritional and metabolic disorders, measuring body composition, caloric intake, energy expenditure, and
metabolism in adults and children with HIV. These studies include nutritional and metabolic disorders found
in HIV infection, including abnormalities in intestinal enzymes, perturbations of normal intestinal flora,
endocrine and cytokine dysregulation as contributing factors to wasting and other metabolic disturbances,
and development of nutritional interventions for AIDS and evaluating parenteral nutritional therapy. n
September 1990, the PHS called for increased research on wasting and other nutritional deficiencies
associated with AIDS. The NIH's AIDS Program Advisory Committee (APAC) echoed the recommendations
of the PHS on this matter. In FY 1991, seven NIDDK grants were funded for research on wasting and
other metabolic and nutritional disorders at a cost of $1.2 million. For FY 1993, NIDDK put research on
wasting at the top of its wish list, asking to fund 13 new grants on wasting. PHS and DHHS cut NIDDIK's
budget request, making these new wasting grants unlikely. This is lip service at its worst. First the PHS
recognizes research on wasting as a priority and then refuses to fund it. In 1991, NIDDK grantees also
conducted studies on how TNF and IL-1 contribute to metabolic dysfunction in AIDS; the biochemical basis
of muscle wasting in AIDS; hepatic metabolism in patients with the wasting syndrome; the therapeutic use
of indomethacin, hydrazine sulfate, and fish oil in the wasting syndrome.
Digestive Disease. NIDDK also supported investigations of the complications of HIV and its opportunistic
sequelae in the digestive system. This work has focused on studies of GI cell infection by HIV, the
physiological basis of AIDS enteropathy, the pathogenesis of cryptosporidiosis, and liver damage. Despite
voluminous documentation by NIDDK, actual work supported in 1991 on the effects of HIV and Ols on the
GI system amounted to just two grants costing $331,992. NIDDK wanted to award 10 new grants for this
work in FY 1993, but expansion was rebuffed by the Executive Branch.
Endocrinology. In 1991, NIDDK funded 11 grants on the neuroendocrine-immune interactions in HIV
infection. Endocrine, immune and nervous system interactions in HIV infection have received little attention.
The PHS "Strategic Plan for AIDS," in 1990, called for increased emphasis on research on these endocrine
abnormalities. NIDDK wanted to fund an additional eleven grants in this area for FY 1993.
Kidney + Uroloaic Disease. NIDDK supports research on AIDS and HIV in the genitourinary tract; renal
complications of AIDS; and the effect of cytokines on glomerular epithelial cell pathology, the effect of
vasectomy on transmission of HIV, and the resulst of kidney transplants among patients with HIV. In 1991,
NIDDK funded five awards for genitourinary and kidney AIDS research at a cost of $1.4M.
Hematopolesis. Work in 1991 largely focused on the hematopoietic defects in AIDS: whether they were
caused by impaired production of colony stimulating factors, such as IL-3 and GM-CSF, by hematopoietic
accessory cells (e.g. T cells and/or monocytes) or by direct infection by HIV of progenitor cells? Other work
focused on the effects of AZT, acetaminophen, and other drugs on the production and differentiation of
myeloid and erythroid progenitor cells. NIDDK supported eight grants in this area in FY 1991 at a total cost
of $1M. For 1991, NIDDK requested $741,000 for three additional grants on bone marrow function in
AIDS. While NIDDK's efforts should be applauded, perhaps since the institute has a small AIDS budget,
it might be wiser to leave support of studies in this area to the larger institutes sponsoring investigations
in this area such as NHLBI, and direct the funds towards the work on wasting, neuroendocrine and immune
system interactions, and gastrointestinal complications of HIV infection, which have little support outside
of NIDDK.
Intramural Research. NIDDK spent $1M on intramural AIDS research in 1991 at the following labs:
Laboratory of Chemical Biology: AIDS-Transcriptional regulation by t-protein and LTR of HIV in vitro;
Laboratory of Chemical Physics: Structural studies of AIDS proteins by NMR; Investigations of
macromolecular structures and dynamics by NMR; Laboratory of Bloorganic Chemistry: Mechanistic
enzymology of HIV proteins; Halogenated biogenic amines in biochemistry and pharmacology; Laboratory

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