Anthony Fauci’s enduring impact on the AIDS crisis

AAfter 38 years as director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci announced on Monday that he would step down from his position in December. Appointed to this position in 1984 by then-President Ronald Reagan, Fauci has personally overseen the federal government’s response to some of the deadliest infectious diseases of the 20th century – from tuberculosis and COVID to SARS and MERS.

But as I said The guard In 2020, “HIV really defined my career and my identity.” HIV prevention and treatment has been a priority research area for NIAID since 1986 and one that Dr. Fauci dedicated much of his public service. The current state of AIDS research and control in America is due in no small part to his ongoing efforts in this area.

NIAID is one of 27 specialized institutes and centers that make up the National Institutes of Health (NIH), which in turn reports to the Department of Health and Human Services. Overall, the NIH serves as the federal government’s premier health research program. Operating within this bureaucratic framework, NIAID conducts and supports “basic and applied research to better understand, treat, and ultimately prevent infectious, immunological, and allergic diseases,” according to its mission statement. That includes everything from working to mitigate the effects of the annual influenza strain and alleviating asthma in urban youth to leading the development of an effective vaccine against COVID-19. The technology behind this vaccine is now being adapted for use against HIV and malaria.

Fauci worked at the forefront of immune regulation research in the early 1980s, developing treatments for a class of otherwise fatal inflammatory diseases including polyarteritis nodosa, granulomatosis with polyangiitis (formerly Wegener’s granulomatosis), and lymphomatoid granulomatosis. The results of these studies helped lay the foundation for current research at NIAID’s Immune Regulation Laboratory. This research includes cellular and molecular mechanisms of HIV immunopathogenesis and the treatment of immune-mediated diseases. The combination of the institute’s nearly four decades of HIV/AIDS research and cutting-edge genomic technology has brought us not one but three potentially viable AIDS vaccines, all of which are currently in clinical trials.

“Finding an HIV vaccine has proven to be a daunting scientific challenge,” said Dr. Fauci in a March NIAID publication. “With the success of safe and highly effective COVID-19 vaccines, we have an exciting opportunity to learn if mRNA technology can achieve similar results against HIV infection.”

The active, hands-on approach we see today in response to the AIDS epidemic is a far cry from that of the Reagan administration at the beginning of the crisis in 1983, which initially met the issue with silence. That is, outside of the time Larry Speakes, Reagan’s press secretary, called it “the gay plague.”

Fauci’s initial efforts during the AIDS epidemic did more harm than good. In 1983 he published Acquired immunodeficiency syndrome: The ever-expanding clinical spectrum In it, he warned of “the possibility that routine close contact, such as within a family household, could spread the disease.” We now know that HIV doesn’t work that way at all, but at the time – although the study urged caution until more evidence is gathered – it caused a moral panic in the media. The study was subsequently seized upon by right-wing organizations and used as a political bludgeon to blame the LGBTQIA+ community for the disease.

Reagan himself did not publicly mention the crisis until 1985, three years after it was officially identified by the CDC (and coincidentally a month after he admitted his involvement in the Iran-Contra scandal). The social stigma surrounding the disease made it nearly impossible to raise funds for basic health research and was exacerbated by Reagan’s repeated budget cuts to the NIH and CDC.

“The lack of funding to date has severely limited our work and likely deepened the invasion of this disease into the American population,” wrote a CDC staffer in an April 1983 memo to then-Deputy Director Dr. Walter Dowdle. “Also, the wasted time getting money from Washington has instilled an air of desperation in AIDS workers across the country.”

Even after his appointment as chief medical officer — one determined to handle the AIDS crisis with the severity it deserved — Fauci faced backlash from the LGBTQIA+ community, which called for greater government action in response to the crisis and attempted to accelerate the glacial pace of drug studies at the time.

By 1990, community patience had reached a breaking point, leading to an attempt by ACT UP (AIDS Coalition to Unleash Power) to storm the NIH in protest. “One of the things the people at ACT UP have said is that we are the people experiencing this novel disease and we are the experts, not just the scientists and doctors,” Garance Ruta, executive director of GEN magazine and an ACT UP member at the protest, relates The Washington Post in 2020.

“I tried to include them in all clinical trial planning meetings,” Fauci said WaPo, In response. “I felt strongly that we had to involve them in the planning process because they weren’t always right, but they had very, very good input.”

Over the past 30 years, the NIH has helped advance the development of numerous antiretroviral therapies. Azidothymidine (AZT), the first drug discovered to inhibit HIV replication without damaging cells, was originally developed by the NIH in the 1960s as an anticancer drug. Its use as an antiretroviral drug, approved by the FDA in 1987, helped establish the AIDS Clinical Trials Group (ACTG), which continues research into nucleoside reverse transcriptase inhibitors (NRTIs, the class of drugs to which AZT belongs). accelerated. NIAID-funded studies in the 1990s helped establish combination therapies that combine multiple drugs for a synergistic effect and investigated a newly identified class of drugs, non-nucleoside reverse transcriptase inhibitors, or NNRTIs.

Number of HIV pills

NIAID

Today, nearly three dozen antiretroviral drugs are available, many combined in fixed-dose tablets. In the 1990s, people with AIDS were expected to take up to 20 single pills at set times throughout the day. The average life expectancy for someone infected with the disease was about a year. Assuming you are lucky enough to live in the developed world, AIDS has now become a chronic condition that can be controlled with a single daily pill. For the 20 million people living with AIDS but without access to modern treatment, it remains a death sentence.

The state of medical research technology has also evolved, although the nation’s prevailing notions of fairness and equality have not improved significantly in the past few years since Reagan came to power. Advances in laboratory standardization and automation have rapidly shortened development cycles and outlier occurrences. The tedious tasks that were once done by lab assistants are now done by robotic arms equipped with pipette arrays.

Disease prevention and diagnosis efforts have been augmented in recent years by artificial intelligence and machine learning algorithms. They have also found use to help stem the spread of HIV and increase access to retroviruses and PReP with applications including “ML with smartphone-collected and social media data to advance HIV risk reduction in real-time, virtual reality Tools to facilitate HIV serostatus disclosure and chatbots for HIV education,” argue Drs. Julia Marcus and Whitney Sewell from Harvard and UMass Amherst, respectively.

And like dr. Fauci, specifically, isn’t retiring – “I want to use what I’ve learned as NIAID director to continue advancing science and public health, and to inspire and mentor the next generation of science leaders as they do so.” help prepare the world to face future infectious disease threats,” he noted in Monday’s announcement — NIAID’s work is far from over. Even as we slowly defeat existing scourges like COVID and HIV, threats like monkeypox (not to mention old killers like polio) will continue to crop up on our rapidly warming planet.

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Russell Falcon

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