Enhanced NIH Funding Vital For Success in Battle Against AIDS

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If there’s any question about the value of U.S. investments in scientific research on HIV/AIDS, Anthony Fauci probably put it to rest today by noting that in the period since HIV first emerged, “we went from a 26-week lifespan to a 40-year-plus life span” for those infected with the virus. Talk about measureable outcomes.

That dramatic change—from death sentence to chronic manageable disease—is thanks, in large part, to the 30-plus antiretroviral drugs developed through scientific inquiry over the last three decades. Fauci’s remarks came at congressional briefing today, entitled “AIDS Research at NIH: New Opportunities to Change the Course of the Epidemic,” sponsored by the HIV Medicine Association, IDSA’s Center for Global Health Policy, and several other groups.

Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases, and other presenters, including two IDSA physician-scientist experts, spoke of the vital need to maintain and increase U.S. support to combat the HIV/AIDS epidemic, whether through an eventual vaccine or biomedical and behavioral prevention strategies.

There is a presumption in some quarters, Fauci said, “that we really have our arms around this and things are stable.”  But with 2.7 million new infections each year, the epidemic is still spiraling.

“In the U.S.,” Fauci added, “yes, things are stable, but they are stable at a completely unacceptable level.” There are about 1.1 million people living with HIV in the U.S., with 56,300 new infections each year–a number that has stayed intractably level for the last decade.

Right now, “we are not winning the game,” Fauci said, which means it is imperative to continue the search for a cure.

“Some have thought this is an impossible goal,” he said. But while there have been many disappointments in the vaccine arena, Fauci said there is great hope of a “functional cure,” in which HIV patients are treated aggressively and early enough that they  go into permanent remission and no longer requirement ARV therapy.

“This is eminently feasible,” he said, describing novel prevention approaches now under study, including microbicides and “test and treat” strategies.

Dr. Wafaa El-Sadr, director of Columbia University’s International Center for AIDS Care and Treatment Programs, said that with ARVs, an estimated 3 million lives have been saved.

“I call that success,” she said. But noting there’s still much “unfinished business,” she said, “we should be energized to continue this work” both in expanding access to treatment, finding new drugs, and researching new prevention tools.

She noted that in parts of the U.S., including D.C., the prevalence of HIV surpasses the rates in some African populations, but that here, it is a very localized epidemic, with African Americans disproportionate impacted. That requires distinct approaches to treatment and prevention.

“We have to reconceptualize our approach to the epidemic,” she said, and look for more structural, socio-economic interventions. But to do that, and be successful, requires more research. She pointed to a study she’s involved with that is trying to identify the risk factors for HIV among women. Once the study gives them some answers, she said, they will need to do another study to figure out what interventions work to mitigate those risk factors.

Dr. El-Sadr also described the “test and link-to-care” study underway in Washington, D.C., and the Bronx, which will look at whether it’s possible to significantly reduce transmission with such an approach.

“This is the epitome of a complex study,” she said, “but it’s the future of what HIV prevention will look like.”

“… We have an emergency in this country and an emergency around the world,” she concluded.  “There’s a need to continue an ambitious, innovative, courageous research agenda.”

Dr. Adaora Adimora, a professor of medicine and epidemiologist at the University of North Carolina, took the audience in a different direction, with a talk about why it is vitally important to cultivate and support minority researchers in this field.

She joked that the subtitle of her presentation should have been: “Why can’t white men solve all our problems?” But  Dr. Adimora quickly turned serious in noting that HIV disproportionately affects minorities, particularly those who are disadvantaged and therefore  vulnerable to forces that put them in the path of the virus.

“Minority investigators bring a unique perspective” on the health issues that affect their community, and are likely to think of research questions and connections that other researchers do not.

For example, until the early 1990s, the HIV-STD field focused research questions on “numbers of parents and sexual behaviors,” she said. “Poverty was recognized as a risk factor but it wasn’t clear how being poor could get you an STD, including HIV. Through the efforts of researchers, many of whom are minorities, this view broadened to include the importance of social forces and the pathways that link these social forces to HIV and other STDs.”

And understanding these pathways is critical to developing successful interventions, she added.

Lack of funding is the main reason that minority researchers leave the field, she said, noting that an early NIH grant was the key to her own successful career in research.

“It’s unlikely my career would have survived” if not for that grant because, she said, she would have had to devote all her time to seeing patients. “An increase in grant funding is critical to ensure that more talented investigators of all races and ethnicities are not lost,” she said.

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