AIDS Research at the NIH: A Critical Review

focuses on the biomedical, clinical and behavioral aspects of HIV infection in middle-aged and older
individuals. NIA is concemrned with how aging and its associated immune changes affect the course of HIV
disease and response to treatment in these populations. NIA places a special emphasis on behavioral
research focused on AIDS-related behaviors and behavioral change in the middle and later years, the
impact of a diagnosis of AIDS on families and social networks, and the impact of AIDS on health care of
older individuals. In addition, NIA, in collaboration with NICHD, NCNR and USAID, supports an
international behavioral research program involving AIDS education program for women in Botswana.
In FY 1991, NIA supported three extramural projects at a cost of $385,000, including an interagency
agreement with CDC to support part of a study social and behavioral aspects of AIDS (the PI is Gary
Noble); a study of the effect of age on HIV disease and immunsuppression in mice; and the education
program described above. In FY 1991, NIA spent $600,000 on intramural AIDS research. "The Clinical
Immunology Section conducts research on the immune deficiency of aging as well as the host response
to HIV. The goals of the age related research are to understand and reverse the appearance of nonfunction[al] lymphocytes in the older individual. The work deals with activation events, pathways leading
to activation, and the effect of growth factors and cytokines on activation and suppression. The HIV related
research deals with the increased morbidity and mortality seen in the older AIDS patient and the response
of the immune system to the HIV which is responsible for the appearance of HIV-related illnesses." The
CIS also collaborated on a trial of HIV gpl60-vaccinia recombinant vaccine with investigators at Johns
Hopkins. Two additional clinical trials, one of human growth hormone and the other of arginine (which
stimulates endogenous production of HGH), were conducted to investigate the immunomodulatory effects
of these agents in non-HIV-infected subjects. No effect on immunological parameters was observed.
Future Plans. In its wish list for FY 1993, NIA asked for:
* An extra $499,000 for intramural immunology work on the host response to HIV;
* $1.5M to expand AIDS information and risk behavior studies to persons 55 years and older;
* Five new AIDS FTEs for a total of ten.
NIA's request for an increased allocation was denied. For FY 1994, NIA will again request an additional
$1.5M for AIDS-related behavioral and social research.
Recommendations. NIA's basic research on the host response to HIV and the particular course of HIV
infection in older individuals is a valuable program. The other basic immunology conducted by the Clinical
Immunology Section, LCP, on lymphocyte activation, growth factors and cytokines, and its interest in
boosting the immune response of the older individual are useful and applicable to AIDS. The budget
increases requested by NIA, a modest amount - only $1.5M - should be honored in full.
11/17. National Library of Medicine (NLM)
The NLM Act of 1956 mandated an NLM to collect, preserve and disseminate the world's published medical
information. Since 1964, NLM initiated several on-line computerized medical information databases,
including MEDLARS and MEDLINE. In the Health Omnibus Program Extension (HOPE) act of 1988 [P.L.
100-607] Congress directed the NLM to develop several AIDS-related research databases. The AIDSLINE
database was created within the NLM's MEDLARS information retrieval system. AIDSLINE is updated with
over 800 citations monthly, which are also available in its printed periodical AIDS Biblioaraphv. Additional
databases are being added to AIDSLINE, including AVLINE, BIOETHICSLINE, CANCERLIT, CATLINE,
HEALTH and POPLINE. "Access is charged at MEDLINE rates... [and] is available... on both the IBM and

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