AIDS Research at the NIH: A Critical Review

lupus. The four grantees are studying questions which go to the heart of several unresolved issues of
AIDS pathogenesis. The Columbia investigators have hypothesized that persons developing DILS may
progress much more slowly. Elucidation of the mechanisms of PARS and DILS, and development of
treatments if necessary, is a vital area long ignored by mainstream research. The NIAMS program, while
tiny and new, needs rapid expansion to address these and other questions. Cutaneous and rheumatic
manifestations of HIV affect quality of life and may affect disease progression. The skin is perhaps the
largest immunological organ of the body, and one of the least well understood (along with the mucosal
epithelia within). Studies of homing patterns among lymphocytes, macrophages and dendritic cells, and of
primary and secondary immune responses occurring in situ as well as in peripheral lymphoid organs,
should help to further elucidate the pathogenesis of AIDS.
Funding. NIAMS spent $1.63M on AIDS in FY 1991, comparable to $1.73M in FY 1992. This amounts
to 0.8% of its total budget, and just 0.2% of NIH's AIDS budget. NIAMS wanted to double its program in
FY 1993 (to $3.431M), but the President provided a mere $86,000 increase (5%) to $1.81M. NIAMS has
4 AIDS FTEs and would have added 2 more next year.
Future plans. The ICD Directors' Wishlist for FY 1993 included the items on the list below. These new
initiatives are infeasible without more support:
* $848,000 to double the current R01 program investigating skin and joint disorders in AIDS;
* $576,000 to triple current studies of Langerhans/dendritic cells as potential reservoirs or accessory
cells in HIV infection;
* $360,000 to expand epidemiological studies of the rheumatic and skin manifestations of HIV in
military populations, minorities and children with HIV.
Recommendations:
* NIAMS, in its intramural program, should address the parallels between AIDS and autoimmune
phenomena such as lupus and rheumatoid arthritis, and alloimmune phenomena such as GVHD.
* Congress should increase the NIAMS AIDS budget to the $3.7M requested for FY 1993.
* Studies of cutaneous and autoimmune (PALS, DILS) manifestations of HIV should be expanded.
11/16. National Institute on Aqina (NIA)
NIA was founded in 1974 following the 1971 recommendation of the White House Conference on Aging,
and was given responsibility for "biomedical, social and behavioral research and training related to the
aging process and diseases and other special problems and needs of the aged." NIA runs a Gerontology
Research Center in Baltimore, MD, where most of its intramural research is conducted. The NIA
Laboratory of Neurosciences conducts basic and clinical research at the NIH Clinical Center. NIA runs
eight intramural laboratories in Clinical Physiology, Behavioral Sciences, Personality and Cognition, Cellular
and Molecular Biology, Biological Chemistry, Molecular Genetics, Cardiovascular Sciences, and
Neurosciences. NIA's Extramural Division has eight subdivisions: Biomedical Research and Clinical
Medicine, Molecular and Cell Biology, Geriatrics, the Neuroscience and Neuropsychology of Aging,
Behavioral and Social Research, Adult Psychological Development, Social Science Research on Aging,
and demography and Population Epidemiology.
NIA spent $985,000 on AIDS-related projects in 1991. For next year, it requested $3M. The President cut
this down to $1.05M, less than that needed to maintain current services ($1.13M). NIA AIDS research

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