NIAID's HIV/AIDS Research Program
Although progress has been made in the global fight against HIV/AIDS, the epidemic continues to devastate the United States and the international community with 56,300 new HIV infections each year in the U.S. and an estimated 33 million people living with HIV worldwide. As the leading U.S. government institute for HIV/AIDS research, NIAID is committed to conducting the research necessary to successfully end the fight against HIV/AIDS.
Through laboratories and clinics on the NIH campus in Bethesda, Md., and a vast network of supported research at universities, medical centers and clinical trial sites around the globe, NIAID is working to better understand HIV and how it causes disease, find new tools to prevent HIV infection including a preventive vaccine, develop new and more effective treatments for people infected with HIV, and hopefully, find a cure.
Discovering the Basics of HIV/AIDS
Because of its complex nature, HIV is an extremely tough infectious disease for researchers to combat. A better understanding of the basic biology and relationship between HIV/AIDS and the human immune system is the key to the discovery of new and improved medicines for people infected with HIV and methods for preventing HIV infection, including a vaccine. Through its on-campus laboratories and grant-funded extramural research, NIAID is continuing to explore how HIV infects individual cells and causes disease to unlock new targets to stop the virus and opportunities to enhance the immune system response to infection.
HIV Medicines as Prevention
A key focus of NIAID’s HIV prevention research is examining whether providing a daily dose of antiretroviral medicines to people who are not infected with HIV but who are at high risk of becoming infected can prevent HIV infection. This strategy — known as pre-exposure prophylaxis (PrEP) — is based on the concept that blocking HIV’s ability to multiple once someone is exposed to the virus may prevent the infection from taking hold. NIAID has tested a similar strategy that has successfully prevented mother-to-child HIV transmission. Further, antiretroviral drugs have been successfully used to thwart HIV infection in health care workers and other employees occupationally exposed to the virus when the drugs were taken within 48-72 hours of exposure and continued for nearly a month.
Finding an Effective HIV Vaccine
Historically, vaccines have been our best weapon in the fight against mankind’s worst infectious diseases, including smallpox and polio. HIV, however, is different from other infectious diseases in that the human body seems incapable of mounting an effective immune response to block the virus from progressing to disease. Further, there is not one documented case of anyone being truly cured of HIV infection. NIAID is conducting fundamental research to better understand how the HIV interacts with the human immune system and is testing the most promising vaccine candidates when scientifically appropriate. And although a vaccine to prevent HIV infection remains the goal, NIAID is also examining vaccines that could significantly alter the course of disease and infectiousness of people infected with HIV, which could provide positive health benefits both for infected individuals and the larger community.
Topical Microbicides
Currently, women make up half of all people worldwide living with HIV. Many women are not in a position to refuse sex or negotiate condom use with their male partners, leaving them vulnerable to HIV infection. To provide women with an HIV prevention tool they can initiate, NIAID is testing microbicides — gels, foams or creams — that can be applied topically inside the vagina to prevent sexual transmission of HIV and other sexually transmitted infections. NIAID is also researching topical microbicides that can be applied rectally to prevent HIV infection among men who have sex with men.
The Next Generation of HIV/AIDS Treatments
One of NIAID’s greatest success stories is that its research led to the development of numerous antiretroviral drugs to treat HIV/AIDS turning what was once a uniformly fatal disease into a manageable chronic condition for many. Currently, there are 31 FDA-approved antiretroviral drugs available to people infected with HIV. Although these medications have enabled people infected with HIV to lead longer and healthier lives, drug resistance, tolerability and toxicity remain issues for some patients. NIAID is working to find new and more effective therapeutic products, drug classes, and combinations as well as safe and effective treatments for dangerous AIDS-related co-infections, such as hepatitis, malaria and tuberculosis.
NIAID is also exploring therapies that suppress the amount of HIV to such low levels that an HIV-infected person would no longer need treatment because his or her immune system could keep the remaining virus in check, creating in essence a “functional cure.”
Behavioral Interventions
HIV prevention is not a one-size-fits all approach. To be successful, we must understand the sociocultural factors that contribute to HIV risk or protection, particularly among communities at greatest risk for HIV infection. NIAID is developing and testing behavioral interventions focused on men, women and adolescents at high risk for HIV infection and interventions geared toward people infected with HIV to reduce their risk of transmitting HIV to others. The strategies under investigation are multifaceted and include HIV counseling, testing for HIV and sexually transmitted diseases, substance abuse and mental health screenings, and referral for medical treatment and care.
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