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transplant rejection.

A recent clinical trial compared the efficacy of the

new monoclonal in combination with cyclosporine A (standard immunosuppressive

treatment for transplant patients) versus cyclosporine A alone in preventing

early kidney graft rejection episodes.

There was a statistically significant

reduction in early kidney graft rejection episodes in the group receiving the

combination therapy.

History has taught us that new and re-emerging microbes are a constant

threat to the survival of our species.

AIDS offers the most striking example

in recent times of the potentially catastrophic impact of a new infectious


Worldwide, an estimated 10 million people are infected with the

human immunodeficiency virus (HIV).

In the United States, more than 1 million

people are infected, and as of January 1 there have been 160,000 cumulative

cases of AIDS and 100,000 deaths.

AIDS is now the second leading cause of

death for young men ages 25 to 44 in the United States, surpassing heart

disease, cancer, and suicide.

The pattern of AIDS in the United States, however, is changing


Increasingly, AIDS is becoming a disease of heterosexuals,

infants and children, women, and minorities.

By the end of 1988, AIDS had

become the fifth leading cause of death in the United States among Black women

ages 25 to 44; by the end of this year, it is expected to be among the five

leading causes of death among all women of reproductive age.

We have taken several steps to identify research needs associated with HIV

infection in women, including establishment of a women's health committee

within the NIAID AIDS clinical Trials Group, to ensure that the issues

involving HIV-infected women are fully integrated into the NIAID research


In December 1990, NIAID coordinated the first national Public Health

Service-sponsored conference on women and HIV infection.

The conference

highlighted how the complex roles of women in the family and society compound

not only their own suffering but also their ability to participate in clinical

research studies.

NIAID has also focused on improving participation of minority constituents

and health professionals in our research programs.

To help recruit minorities

into clinical trials, we have provided supplemental grants to AIDS Clinical

Trials Units.

In addition, we have recently awarded funds to three

institutions that primarily serve minority populations to help them build the

infrastructure necessary to conduct clinical trials.

This past year has yielded benefits from prior Investments in basic and

clinical research in AIDS.

One of the major advances in prolonging the lives

of people infected with HIV has been the use of zidovudine (AZT) and

prophylaxis for Pneumocystis carinli pneumonia (PCP). Preliminary evidence

indicates that in people with low T4 cell counts, appropriate therapy doubles

their expected survival time after diagnosis from 12 to 24 months.

AZT, however, is an imperfect drug, and hence we are actively searching

for new drugs to treat HIV infection.

Preliminary studies suggest that the

combination of AZT and dideoxycytidine (ddC), given in alternating doses, has

the same benefit but is less toxic than continuous therapy with AZT.


promising drug. dideoxyinosine (ddl), is being studied in Phase II clinical

trials in parallel with expanded distribution to patients not eligible to

enroll in the controlled trials.

Several studies of interferon alpha, either

alone or in combination with AZT, have been conducted in persons with early

HIV infection.

These studies have shown that interferon alpha appears to both

slow virus production and reduce the risk of developing AIDS-related

opportunistic infections when administered to asymptomatic HIV-infected


We have also made major strides in treating AIDS-related opportunistic


As a result of a large multicenter clinical trial, the drug

fluconazole has replaced an effective but more toxic drug as maintenance

therapy to prevent recurrences of cryptococcal meningitis, a life-threatening

infection of the brain and nervous system.

Studies conducted by NIAID and the

National Eye Institute also showed foscarnet to be effective in delaying

progression of cytomegalovirus retinitis, a sight-threatening eye infection

affecting many people with AIDS.

There have been encouraging results from AIDS vaccine research studies

this past year.

Studies in monkeys using whole killed simian immunodeficiency

virus (a monkey AIDS virus) vaccination followed by live virus challenge show

promising indications of protection.

Other developments included the entry of

several new AIDS vaccines into Phase I clinical trials.

We are now confident

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that a candidate vaccine for large-scale testing in uninfected volunteers will

be identified within the next few years.

From the unexplored mysteries of the immune system to the threat of new

and re-emerging microbes, NIAID faces important challenges in the decade of

the 1990s.

Our commitment to basic research in immunology and microbiology

has in the past positioned us well to meet such challenges.

Our renewed

commitment to this approach will surely allow us to turn these challenges into

opportunities to alleviate and hopefully prevent suffering and death caused by

infectious diseases and disorders of the immune system.

Mr. Chairman, the FY 1992 budget request for this Institute is


I will be pleased to answer any questions you may have.

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1966-1967, Intern, Department of Medicine, New York Hospital-Cornell Medical
Center, 1967-1968, Assistant Resident, Department of Medicine, The New York
Hospital-Cornell Medical Center. 1968-1970, clinical Associate, Laboratory of
Clinical Investigation, National Institute of Allergy and Infectious Diseases
(NIAID), National Institutes of Health (NIH), Bethesda, Maryland. 1970-1971,
Senior Staff Fellow, Laboratory of Clinical Investigation, NIAID, NIH,
Bethesda, Maryland. 1971-1972, Chief Resident, Department of Medicine, New
York Hospital-Cornell Medical Center; Instructor in Medicine, Cornell Medical
College. 1972-1974, Senior Investigator, Laboratory of Clinical
Investigation, NIAID, NIH, Bethesda, Maryland. 1972-present, Consultant in
Infectious Diseases, The National Naval Medical Center, Bethesda, Maryland.
1974-1980, Head, Clinical Physiology Section, Laboratory of Clinical
Investigation, NIAID, NIH, Bethesda, Maryland. 1977-1984, Deputy Clinical
Director, NIAID, NIH, Bethesda, Maryland. 1980-present, Chief, Laboratory of
Immunoregulation, NIAID, NIH, Bethesda, Maryland. 1984-1988, clinical
Professor, Department of Medicine, Division of Rheumatology, Immunology, and
Allergy, Georgetown University School of Medicine, Washington, D.C. 1985.
1988, Clinical Professor, George Washington University School of Medicine and
Health Sciences, Washington, D.C. 1984-present, Director, NIAID, NIH,
Bethesda, Maryland. 1988-present, Director, Office of AIDS Research, NIH, and
Associate Director of NIH for AIDS Research, Bethesda, Maryland.

Board Certification and Military Service:

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American Board of Internal Medicine - June 21, 1972. American Board of Allergy and Immunology-March 1, 1974. American Board of Infectious Diseases - October 15, 1974. U.S. Public Health Service, July 1968 - June 1970; July 1972-Present.

Professional Organizations:

American Federation for Clinical Research, American Association for the
Advancement of Science, American Association of Immunologists, American

Medical Association, Fellow of the American Academy of Allergy, Infectious Diseases Society of America, American Society for clinical Investigation, Fellow of The American College of Physicians, Association of American Physicians, Collegium Internationale Allergologicum, Charter Member of the clinical Immunology Society. The Institute of Medicine of the National Academy of Sciences (USA).

Offices Held:

Councillor, Eastern Section, American Federation for clinical Research (AFCR). 1977. National Councillor, AFCR, 1978-1979. President, AFCR, 1980-1981, Recorder, Association of American Physicians, 1988-present.

Advisory Boards and Committees:

Chairman, Allergy and Imunology Committee, MKSAP V, American College of
Physicians. Advisory Panel, The American Board of Medical Laboratory
Immunology. Member, Committee on clinical Immunology and Immunopathology,
American Association of Immunologists, 1980-1985. Representative of American
Association of Immunologists to the Examinations Committee of the American
Board of Allergy and Immunology, 1981-present. Postgraduate Education
Committee, American Academy of Allergy, 1979-1982. Member, NIAID Study Group
on Immunology, 1980. Member, Section of Physiology in Clinical Science of the
American Physiological Society, 1980-1984. Member, Subcommittee on the
Classification of vasculitis, American Rheumatism Association 1980-present.
Ad Hoc Committee, The National Foundation for Infectious Diseases, 1980-
present. Subcommittee on clinical Sciences, Publications Committee, American
Physiological Society, 1980 - 1984. American Association of Immunologists,
1982-1985. Member, NIAID Working Group for AIDS, 1982-present. Member,
American Federation for Clinical Research President's Public Policy Advisory
Committee, 1983.present. Board of Directors, American Board of Allergy and
Immunology, 1984-1987. Participant in the USA · People's Republic of China
Immunology Cooperative Agreement, August 10-22, 1983, Beijing and Shanghai,
PRC. Member, Scientific Advisory Board, Medical Biology Institute, La Jolla,
CA, 1983-1984. Participant in the USA-Japan Eye Immunology Advisory
Conference, November 27 to December 1, 1983, Honolulu, HI. Member, External
Advisory Committee, Multipurpose Arthritis Center, Duke University Medical
Center, 1984-present. Member, Honorary Advisory Board, Italian-American
Medical Association, 1984-present. Member, Peripatetic Club, 1984-present.
Ex Officio Member, National Diabetes Advisory Board, 1984 - present. Ex Officio
Member, National Digestive Diseases Advisory Board, 1984-present. Chairman,
Search Committee for Director, National Institute of Child Health and Human
Development, 1985. Member, Department of Health and Human Services Task Force
on Alzheimer's Diseases. The Albert Lasker Medical Research Award Jury, 1985-
present. Deputy Ethics Counselor, Department of Health and Human Services,
1985-present. Member, Department of Health and Humans Services Committee to
Coordinate Environmental and Related Programs, 1985-present. Member,
Scientific Organizing Committee, Joint Meeting of the Italian Society of
Immunology and Immunopathology-National Institutes of Health on "Human
Lymphocyte Activation," Florence, Italy, September 5-7, 1985. Member, United
States Delegation to the United States-Japan Cooperative Medical Science
Committee, 1985-present. Member, U.S. Public Health Service AIDS Executive
Task Force, 1985-present. Chairman, NIH AIDS Executive Task Force, 1985.
present. Coordinator, NIH AIDS Research, 1985-present. Member, Scientific
Seminar Subcommittee, National Institutes of Health Centennial Program, 1985-
1987. Member, Advisory Board, Clinical Immunology Newsletter, 1986-1988.
Member, Scientific Organizing Committee, International Conference on
Lymphocyte Activation and Immune Regulation, Newport Beach, CA, February 28-
March 2, 1986. Member, Planning Committee, clinical Immunology Society, 1986.
Member, International Advisory Committee, International Conference on AIDS,
Paris, France, June 23-25, 1986. Member, Advisory Group, Institut
Scientifique Roussel-Uclaf, 1987-1989. Ex Officio Member, National Kidney and
Urologic Diseases Advisory Board, 1987-present. Member, International
Programme Committee, 8th International Congress of Immunology, Budapest,
Hungary, 1987. Member, International Advisory Committee, IVth International
Conference on AIDS, Stockholm, Sweden, June 12-16, 1988. Member, NIH Resource
Allocation Group, 1987-1989. Member, Committee for the Coordination of

Research Programs on the Acquired Immunodeficiency Syndrome of the Ministry of
Health of Italy, 1988-present. Institute of Medicine Roundtable for the
Development of Drugs and Vaccines Against AIDS, January 17, 1989, through
December 31, 1991. Member, Selection Committee for the National Public
Service Awards, 1990.

Editorial Boards:

Dr. Fauci has been or is on the Editorial Board of 27 scientific Journals in the field of immunology, allergy and Infectious diseases. These include: The Journal of Clinical Investigation, The Journal of Immunology, Journal of Infectious Diseases, Journal of Clinical Immunology. Dr. Fauci is also the Editor of one of the major textbooks of medicine in the world, "Harrison's Principles of Internal Medicine. "

Awards and Honors:

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Alpha Omega Alpha. Kileen Prize for Excellence in Chemistry (College of the Holy Cross). John Metcalfe Polk Prize for General Efficiency (Cornell University Medical College). Alfred Mortitz Michaelis Prize for Efficiency in General Medicine (Cornell University Medical College). U.S. Public Health Service Meritorious Service Award, 1979. Arthur s. Flemming Award, 1979 Given to the 10 outstanding employees in the U.S. Federal Government. Squibb Award of the Infectious Diseases Society of America, 1983. U.S. Public Health Service Distinguished Service Medal, 1984. Food and Drug Administration Commissioner's Special Citation, 1984. 1985 Citation Classics (Current Contents) for article A.S. Fauci, D.C. Dale, and J.E. Balow: Glucocorticosteroid therapy: mechanisms of action and clinical considerations. Ann. Intern. Med. 84: 304 -315, 1976. Who's Who in America, 44th Edition. Who's Who in Science and Technology, 2nd Edition. 1985 Stanford University Center Survey of the American Rheumatism Association membership ranked the work of Dr. Anthony s. Fauci on the treatment of polyarteritis nodosa and Wegener's granulomatosis as one of the most important advances in patient management in rheumatology over the past 20 years. The Clemens von Pirquet Award of Georgetown University Medical Center, 1986. Doctor of Science, Honoris Causa, College of the Holy Cross, Worcester, MA May 29, 1987. The Kober Lecture Award of the Association of American Physicians, 1988. Public Health Leader of the Year Award of the Commissioned officers Association of the U.S. Public Health Service, 1988. The National Institutes of Health clinical Center Annual Distinguished clinical Educator Award, 1988. 1988 Citation Classics (Current Contents) for article · A. S. Fauci, B. F. Haynes, P. Katz: The spectrum of vasculitis. Ann. Intern Med. 89: 660-676, 1978. The Leadership Award of the Columbus Citizens Foundation, Inc., for "Inspired Leadership and Outstanding Achievement in the field of Medical Research, " New York, NY October 8, 1988. American Association for the Advancement of Science/Westinghouse Award for Public Understanding of Science and Technology, 1988. The National Hemophilia Foundation Special Award for Research in AIDS, 1989. The Lee P. Brown National Public Service Award of 1989 presented by the National Academy of Public Administration and the National Society for Public Administration. The Duke University Award for Rheumatologic and Immunologic Research, 1989. The William Beaumont Award of the American Medical Association, 1989. The academic Excellence Award from Children's Hospital National Medical Center, Washington, DC, 1989. The Surgeon General's Exemplary Service Medal, 1989. The Surgeon General's Medallion, 1989. The 1989 Achievement Award of the American Association of Physicians for Human Rights. The 1989 National Medical Research Award of the National Health Council. The Flame of Hope Award of the Terri Gotthelf Lupus Research Institute, November 2, 1989. The 1989 Maxwell Finland Award in Infectious Disease presented by the National Foundation for Infectious Diseases. The 1989 Helen Hayes Award for Medical Research. The Excellence in Public Service Award of the Committee for the Support of Public Service, May 9, 1990. The 1990 Lifetime Science Award of the Institute for Advanced Studies in Immunology and Aging, Washington, DC. Doctor of Science, Honoris Causa, Mount Sinai School of Medicine, New York, NY, May 18, 1990. Doctor of Science, Honoris Causa, Neumann College, Aston, PA, May 19, 1990. Doctor of Science, Honoris Causa, Georgetown University School of Medicine, Washington, DC, May 26, 1990. Doctor of Science, Honoris Causa, Hahnemann University

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