For the past three decades, Dr. Anthony S. Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), has overseen extensive research efforts to prevent, diagnose, and treat infectious diseases, such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria, and illness from potential agents of bioterrorism. A native of Brooklyn, N.Y., Dr. Fauci received his M.D. degree from Cornell University Medical College in 1966. In 1980, he was appointed Chief of the NIAID Laboratory of Immunoregulation, a position he still holds. He spoke with NIH MedlinePlus magazine coordinator Christopher Klose about the continuing challenge of HIV/AIDS.
Is HIV/AIDS much of a threat anymore?
Dr. Fauci: Unfortunately, many people think it is no longer a problem. But HIV/AIDS remains a substantial global health threat. In the U.S., alone, there have been almost 1 million cases so far and over half a million deaths. There are 1.1 million people living with HIV in the U.S., and 21 percent do not know that they are infected. Every year we continue to see about 56,000 new infections here and 2.7 million worldwide. Globally, 33 million people are living with HIV, 90 percent of them in the developing world—with 67 percent concentrated in sub-Saharan and southern Africa.
What benefits have there been from the research over the years?
Dr. Fauci: About 11 percent of NIH's annual budget—approximately $3 billion—goes to AIDS research. We have developed an extraordinary understanding of how the HIV virus destroys the body's immune system. In addition, therapy has been one of the major success stories. We now have more than 30 federally approved drugs for HIV that, when used in combination, have literally transformed the lives of HIV-infected people. Conservatively, an estimated 3 million years of life have been saved in this country from 1996 through 2005. And I do not mean people alive in bed, but out working as productive members of society. The payback from research by the NIH and others has been extraordinary.
Hasn't the HIV research also been helpful in understanding and treating other diseases?
Dr. Fauci: Right. What we know about regulation of the immune system in general comes a lot from the study of HIV/AIDS. That helps us with autoimmune and hypersensitivity diseases, and how the body defends against other infections, and against cancers.
Dr. Fauci: Understanding the precise steps in the replication cycle of HIV has allowed for better diagnosis and treatment, as well as for targeted drug development. We have always been able to target for different infections and cancers, but targeting a drug to block a particular component of the HIV virus, which we've done, has opened the way to do the same for cancer therapy, and for infectious diseases ranging from influenza and tuberculosis to malaria.
Is your ultimate goal a vaccine for HIV/AIDS?
Dr. Fauci: Yes. Developing an HIV vaccine is one of the most challenging scientific problems we tackle. The fundamental principle in vaccines is to mimic natural infection in order to trigger the immune system to mount a successful defense, since the immune response to natural infection almost invariably results in the control and elimination of infection. In this manner, we have developed vaccines against a number of microbial killers — smallpox, measles, polio.
But with HIV, the body is incapable of mounting a successful, natural immune response. Out of the tens of millions who have been infected, there is not a single documented case of anyone's immune system having completely eradicated the HIV virus
from the body. So we have to induce the body to do better than it does naturally.
You're up against a very smart cookie. What is it going to take to protect us?
Dr. Fauci: Ultimately, it comes down to research. Research is discovery; its goal is to answer the unanswered questions. In addition, the technology is extraordinary. So the challenge is to apply fundamental, bright, new ideas in the backdrop of this rapidly emerging technology.
How do you handle all the information?
Dr. Fauci: If you do not have an orderly way to handle the explosion of information about the biological sciences—we call it bioinformatics—it can almost overwhelm you. Fortunately, the National Library of Medicine has pioneered a number of very user-friendly, helpful tools.
What's a good example of a useful information tool?
Dr. Fauci: There is GenBank, for one, which is an annotated database collection of all publicly available DNA sequences. I used to have to go to the library and work my way through volumes of books. Now, I sit at my computer, press a button, and ten seconds later I have what I need. It's amazing.
How do you inspire the new generation of researchers to take on HIV and other challenges?
Dr. Fauci: You make it clear that biomedical research, discovering the unknown, is very exciting. And that they are doing something extremely important: for people's health, the health of the community, the health of the world. That actually making a difference; helping society, is very gratifying.
On the other hand, what do you say to those in the minority communities who are most at risk of HIV/AIDS?
Dr. Fauci: There has to be more open, freer communication about the risk of HIV, and who is at risk and what they can and should be doing to help protect themselves. The numbers are really startling. For instance, although African Americans comprise 12 percent of the population, they account for 45 percent of all new HIV infections nationwide, and 65 percent of all new infections among women. A substantial portion of newly infected African Americans are bisexual and homosexual men.
Unfortunately, there is not much acceptance of being gay in the African American community. People are forced underground. They do not have access to the testing, counseling, and preventive methods proven to help protect against HIV, like the use of condoms. Also, in the natural course of a relationship, many young African American women are unwittingly exposed to HIV because their partners do not know they themselves are infected.
That is why we have to target those people at highest risk, and why the messages of awareness and self-protection must be delivered by community leaders who are respected and understood by the community, not some guy in a suit who shows up in the inner city one day and says, "Just say, 'No.'"
Is there something the average American can do to help in the fight against HIV/AIDS?
Dr. Fauci: Definitely. We need the support of the man and the woman in the street, because ultimately our resources come from the American public. I would ask that people learn more about science and biomedical research and lend their support. The more people understand, the more they will see how what we do here at the NIH is so important to their own lives and to the health of our nation and the world.