AIDS Research at the NIH: A Critical Review

ABSTRACT
Our goal was to obtain a comprehensive picture of the AIDS programs administered
by the US National Institutes of Health (NIH) in order to recommend changes to
expedite a cure. We reviewed the $800M NIH AIDS program from fiscal year (FY)
1991, including 2,625 extramural grants and contracts and hundreds of intramural
projects. We read abstracts of these projects generated by the NIH Office of AIDS
Research (OAR) AIDS Research Information System (ARIS) database. We reviewed
the NIH Annual Report to Conqress on AIDS achievements for FY 1991, the quarterly
Institute AIDS Science Reports, and the list of new programs requested by NIH for
AIDS in FY 1993, which cannot be funded due to President Bush's budget cuts.
Finally, we compared a draft of "The NIH Strategic Plan for HIV-Related Research,"
the Institute of Medicine's 1991 report on the AIDS program, and the
recommendations of the National Commission on AIDS to the government.
NIH spent $800M on AIDS in FY 1991, 9.7% of its total budget. Each of the NIH's 18
Institutes, Centers, and Divisions administers AIDS programs, all of which remain uncoordinated and underfunded. 73% of the programs are administered by two institutes,
NIAID (53%) and NCI (20%). Under the President's FY93 Budget Request, AIDS
programs will increase only 3.8%, or less than scientific inflation. This is a cut of
$456M from the institute directors' original requests. Over a hundred new initiatives
and expansions of existing programs cannot be funded. When new initiatives are
mandated by Congress or the Executive Branch, existing programs are cannibalized.
For instance, the NIAID pool of basic AIDS research grants shrank by half in 1992 to
pay for the ACTG Recompetition and Congressionally-mandated pediatrics research.
We conclude that the entire NIH budget should be doubled, to $16 billion a year. The
AIDS budget should rise to $1.6 billion. The rate at which AIDS basic research grants
are funded should be restored to 40%. The NIH Associate Director for AIDS
Research should be given authority to allocate resources and programs across
institute boundaries. Pathogenesis research should be emphasized. Developmental
clinical immunology programs should be expanded. The six institutes conducting
clinical trials (NIAID, NCI, NICHD, NEI, NINDS, NHLBI) should mandate collaboration
among their research networks. Orphan research areas such as wasting, neurology,
and immune-based therapies should receive special support. NIH should develop a
large scale screening program to search for cytokine inhibitors and synthetic immune
modulators. Clinical trials should be analyzed and published faster. Community
activists should participate in the oversight of basic research programs.