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 disease. 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 dramatically. 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 agenda. 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 carinii 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. Another promising drug, dideoxyinosine (ddI), 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 persons. We have also made major strides in treating AIDS-related opportunistic infections. 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 38-711 0-91-28 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 $976,711,000. I will be pleased to answer any questions you may have. BIOGRAPHICAL SKETCH OF DR. ANTHONY S. FAUCI December 24, 1940. Brooklyn, New York Education: College of Holy Cross, 1962 A.B.; Cornell University Medical College, 1966 M.D. Professional History: 1966-1967, Intern, Department of Medicine, New York Hospital-Cornell Medical Board Certification and Military Service: 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 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 Immunology Committee, MKSAP V, American College of Research Programs on the Acquired Immunodeficiency Syndrome of the Ministry of 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: The 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. 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 |