AIDS Research at the NIH: A Critical Review

* NEI should develop a study of CMV prophylaxis in pediatric populations.
* In view of the increasing use of ddl in children with HIV infection, NEI should work with NCI,
NICHD and NIAID to develop and publicize a diagnostic and therapeutic algorithm for optic neuritis
in children receiving ddl therapy.
* SOCA should work with ACTG, CPCRA, AmFAR, FDA and Burroughs-Wellcome to persuade
Syntex to contribute oral ganciclovir for a 3-arm, 2-drug study of CMV prophylaxis in 1993, using
any or all of the above networks.
* SOCA should consider piloting multicenter trials of albendazole for ocular microsporidiosis and of
566c80 vs. pyrimethamine for ocular toxoplasmosis.
* SOCA should improve relations with the ACTG Viral PSG and should include community activists
on its protocol steering committee(s).
* OAR should list the NEI and SOCA projects in the section of the Strategic Plan concerning
treatments for opportunistic infections.
11/12. Fogarty International Center (FIC)
for Advanced Studies in the Health Sciences
FIC was established in 1967 as a memorial to Rep. John E. Fogarty (Rhode Island). FIC sponsors two
large international AIDS training projects, and is also an NIH liaison to WHO, PAHO and the European
Medical Research Councils. FIC spent $5.35 million on AIDS in 1991. For next year, it asked for $8.5M;
the President cut this down to $5.8M, which is barely enough to maintain current services. A third of FIC's
total budget is devoted to AIDS. The International Training in Epidemiology Related to AIDS program is
funded through D43 grants, a unique activity code specially created for the program. The Intemational
Postdoctoral Research and Training in AIDS program is funded through T22 grants, which are institutional
research fellowships "to support an institution with an approved preceptor for a number of postdoctoral
research training fellowships in a limited number of specified shortage biomedical science areas." Over
the next two years, FIC's efforts are being redicrected towards vaccine development. $2M will be taken
from prevention, education and epidemiology to fund training for vaccine field trials. This transfer of
resources away from prevention and natural history to vaccine infrastructure development is a major
development in the NIH's AIDS program which has, hitherto, received little attention or broad discussion.
What is the impact in developing countries of cutting back on prevention and epidemiology? Are the
vaccine products to be tested promising enough to justify the expense? Are local communities involved?
Will the vaccines, if proven effective, be distributed in the countries where they were proved?
The AIDS International Training and Research Proaram (AITRP) was initiated in 1988 in response to
Congressional pressure to address the international scope of the epidemic. Its goals are 1) to train foreign
epidemiologists; and 2) to foster US-international collaboration on AIDS research. AITRP is an integral part
of the NIH's strategy for developing an infrastructure for future HIV vaccine trials. Other emphases include
the prevention and treatment of opportunistic infections and the unique problems of women and children
with HIV infection. FIC's efforts are coordinated with other international AIDS research efforts administered
by the NIH and other federal agencies, as well as those supported by the World Health Organization's
Global Programme on AIDS (WHO/GPA).
The International Postdoctoral Research and Training in AIDS Program supports collaborative research
and training for US and foreign scientists who want to expand their capabilities in the epidemiology,
diagnosis, prevention and treatment of AIDS. While AIDS researchers from any country and career level
may apply through this program, priority is given to those from developing countries. Four US institutions

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