Guest Director's Update
Marking a Memorable Moment in AIDS Research
By Dr. Robert Yarchoan
Director, NCI's Office of HIV and AIDS Malignancy
I had the honor recently of joining an illustrious group of scientists and scientific leaders at a symposium to honor Dr. Robert C. Gallo on the 25th anniversary of his reports on the co-discovery of HIV, the proof that it was the cause of AIDS, and the development of the first blood test for HIV. The co-discovery of HIV—work done by Dr. Gallo’s group, then at NCI, and that of Dr. Luc Montagnier, then at the Pasteur Institute in France—was a seminal moment in biomedical research. It provided the tools to stop the spread of AIDS by blood transfusion, and allowed researchers to rapidly develop effective treatments for AIDS, which had emerged as a global health threat only a few years earlier.
NCI has played a critical role in HIV- and AIDS-related research from the day in 1981 when one of the first AIDS patients was admitted to the NCI Metabolism Branch. NCI’s advances in AIDS research, in part, resulted from the Institute’s long-term commitment to research on the interrelationship between viruses and cancer. I was fortunate to be part of a research team, alongside Drs. Samuel Broder and Hiroaki Mitsuya, that helped to develop and clinically test the first therapies—zidovudine (AZT), dideoxycytidine (ddC), and dideoxyinosine (ddI)—that could effectively treat HIV. As Dr. Broder pointed out in his talk at the Gallo symposium, this work took place with astonishing speed: HIV was shown to be the cause of AIDS just 3 years after AIDS was recognized, and AZT received FDA approval as the first AIDS drug less than 3 years later. It is estimated that advances in the treatment of HIV infection have saved more than 3 million person-years of life in the United States alone.
Our success in preventing and treating AIDS, however, has also led to many new challenges. Perhaps foremost among them is the increasing problem of cancer and the expanding array of tumor types in people with AIDS. In fact, cancer is emerging as the most common cause of death in HIV-infected patients, many from tumors that previously had not been strongly associated with AIDS, such as cancers of the head and neck, anus, and lung.
We cannot forget that, despite our success, we still do not have an AIDS vaccine, and AIDS kills nearly 175,000 people a month worldwide. In the developing world, many of these deaths are due to AIDS-related malignancies, especially in Africa, where Kaposi sarcoma was a common tumor even before the AIDS epidemic. So, clearly, we still have much to accomplish. That is part of the reason why NCI Director Dr. John E. Niederhuber formed the NCI Office of HIV and AIDS Malignancy (OHAM), a new venture that he has asked me to lead. OHAM’s role will be to coordinate and provide broad oversight for the HIV and AIDS malignancy research at NCI.
NCI’s AIDS- and HIV-related research programs include research on new preventive and therapeutic vaccines, HIV drug resistance, and HIV-related malignancies, among others. OHAM will focus on strengthening collaboration and broadening the impact of NCI’s HIV- and AIDS-related research. Greater collaboration can help bridge work being done in the laboratory and clinic, creating a plethora of opportunities to conduct important translational research.
Yes, there are still significant challenges to overcome, particularly in developing countries where access to modern AIDS therapies can be very limited and where AIDS-related malignancies have exacted a great toll. As Drs. Gallo and Montagnier exhorted in marking the 25th anniversary of their discovery, these are challenges that the world public health community must jointly address.
For my part, it has been gratifying to use science to end human suffering and to see one’s work lead to such progress in a relatively short period of time. I’m hopeful that we will see even greater progress in the next 25 years, and I’m confident that NCI will continue to play a valuable part in this effort.