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Posts Tagged ‘NIAID’

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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Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, delivered a forceful message on the need for a “storm” of attention and resources devoted to developing new TB treatment and prevention efforts.

“It is imperative that we transform the way we diagnose, treat, prevent, and control TB — through biomedical research and public health measures — to the same extent that we have done and will continue to do with HIV/AIDS,” Fauci writes in this commentary on MSNBC’s website today. “We are beginning to see the winds of change, but what we really need is a storm.”

In an echo of the speech he delivered this summer at the Pacific Health Summit in Seattle, Fauci, a powerful leader in infectious disease research, outlined the need for a robust new TB research agenda. “The TB research effort will require a sustained and long-term commitment from government, academia, industry and philanthropy.”

Click here to read the whole piece and here to read our earlier post on Fauci’s remarks in Seattle.

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What will come of Anthony Fauci’s call for a “transformative” research agenda for tuberculosis, in which doctors and scientists get new resources and support in the search for better drugs and diagnostics to combat this ancient scourge?

Fauci, head of the National Institute of Allergy and Infectious Diseases, delivered that appeal for a more aggressive approach to TB last summer, during the Pacific Health Summit meeting in Seattle on the growing threat of drug-resistant TB. The Pacific Health Summit just issued this report on that meeting, providing a fresh reminder of Fauci’s stirring remarks.

“Why don’t we have 30 new drugs for tuberculosis, a disease that we know is eminently curable?” Fauci asked in an opening speech to leaders at the summit. One reason, he suggested, is that “a transforming research effort has not been evident…we are seeing the winds of change, but what we really need is a storm.”

Part of the reason we might not get that storm is highlighted in this very interesting post on scienceline.org about low TB rates in the U.S. and how they may provide false reassurance that TB is not a real (or close) threat. That item includes a great poster from a 1920s public health campaign against TB–the kind of campaign that Dr. Robin Wood talked about during his visit to Washington last week. Click here and here to read more on that.

That blog item and the Pacific Health Summitt report come just as TB gets some needed attention on Capitol Hill, where a Congressional briefing scheduled for tomorrow will focus on “how U.S. investment in global health research has advanced” the scientific quest for more effective TB treatment strategies. Click here to get more info on that event.

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During a live interactive webcast today hosted by the Kaiser Family Foundation, an expert panel agreed that tuberculosis poses a grave global health threat and demands an innovative, multifaceted response—from new drugs to scaled-up treatment to better infection control.

The lively forum, available here, highlighted the need for an aggressive approach to the global tuberculosis epidemic just as the US government is putting the finishing touches on its five-year global tuberculosis strategy. But it’s far from clear the US will provide the leadership and resources needed.

Cheri Vincent, senior public health advisor in the Infectious Diseases Division, Bureau for Global Health, at USAID, said her agency is now mapping out its five-year TB strategy, working in conjunction with PEPFAR, the Department of Defense, and other agencies. One key objective, she said, is to halve TB prevalence by 2015 from 1990 levels. Another goal is to get at least 90,000 patients with multi-drug resistant TB on treatment, she said, noting that right now, very few MDR-TB patients are being treated in adherence with international guidelines.

“We also need to build on the health system platform and make sure we’re doing it in a cost effective and integrated approach,” Vincent said.

Christine Sizemore, Ph.D., chief of the Tuberculosis and other Mycobacterial Diseases Section in NIAID’s Division of Microbiology and Infectious Diseases, noted that in 1985, the research institute’s budget for TB was only $160,000 a year and the disease had fallen off the medical community’s agenda. It popped back up in the 1990s, when an outbreak of drug-resistant TB in the U.S. made scientists realize this was a continuing threat.

Now, she said, the National Institute of Allergy and Infectious Diseases has made a “fairly significant investment” in TB, spending about $140 million a year on TB related research. But, Sizemore said, “We need to start looking at the disease in a larger context.” She said discussions are underway to move toward what NIAID director Tony Fauci has called a “transformative” research agenda for TB. For more on Fauci’s vision, read this post.

Christine Lubinski, director of the IDSA/HIVMA Center for Global Health Policy, said while these steps are vital, the US government’s response still does not reflect the urgency of the epidemic. She noted that when Congress reauthorized the global AIDS initiative, known as PEPFAR, in 2008, lawmakers authorized $4 billion over five years for TB control, but decision-makers are not on track to fulfill that funding commitment.

In the last budget proposal from the White House, “we did not see … even remotely a down payment on that,” Lubinski said. (more…)

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The Kaiser Family Foundation will hold a live, interactive webcast on Tuesday, Sept. 28, at 1 p.m. EDT on the threat of tuberculosis and the U.S. strategy for combating this ancient deadly disease.

An expert panel is set to discuss this growing global health threat, including two of the U.S. government’s top infectious disease specialists and renowned South African physician Robin Wood, who has been on the frontlines of HIV/AIDS treatment, prevention, and research for the last two decades. As director of the Desmond Tutu HIV Centre at the Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Dr. Wood will be able to give his perspective on new strategies needed to combat global HIV/AIDS and TB. 

The Center for Global Health Policy is bringing Dr. Wood to Washington next week for series of community forums, policy meetings, and press interviews. The trip is part of the Global Center’s efforts to make the voices of developing country physicians heard in American policy debates.

Joining Dr. Wood for the Kaiser webcast will be Christine Sizemore, of the National Institute of Allergy and Infectious Diseases; Cheri Vincent, of the U.S. Agency for International Development; and Christine Lubinski, director of the Center for Global Health Policy. Both Dr. Sizemore and Ms. Vincent play lead roles in the U.S. government’s global TB programs. The forum will be moderated by Kaiser Family Foundation Vice President Jen Kates. (more…)

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Editor’s Note: This is another dispatch from the Pacific Health Summit, filed by Christine Lubinski, director of the Center for Global Health Policy.

Following NIAID Director Anthony Fauci’s powerful call for a transformative research agenda for tuberculosis, other presenters highlighted the challenges in wooing pharmaceutical companies, biotech firms and young researchers to the field of TB, given the paucity of resources available and the challenges for industry trying to recoup investments and make a profit for shareholders.

Some argued that a research and development focus on responding to latent TB held the promise of garnering a huge world market, including wealthy countries, with one-third of the world’s population infected with latent TB.  Others identified various potential incentives that might bring more industry involvement to the table, such as donor commitments to purchase products for poor countries and marketing exclusivity commitments.

(more…)

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This live blog is from the Pacific Health Summit in Seattle, a three-day meeting that opened Tuesday night. Its focus is the global response to multidrug-resistant tuberculosis.

Anthony Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, told the Pacific Health Summit today that it was urgent to begin a broad new research agenda to fight tuberculosis around the world.

In an invitation-only meeting involving 250 global TB experts from 25 countries, including representatives that ranged from industry to foundations to governments, Fauci delivered a sweeping “state of the science’’ speech that built a case for a major new sustained TB research effort.

“We have had decades of relative neglect given the extent the of the problem,’’ Fauci said. “There is much catching up to do and this will require a sustained effort’’ with major funding commitments. (more…)

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