AIDS IS STILL A PRESSING ISSUE

AIDS has slipped off page one of most U.S. newspapers, but it's still very much a problem here, and even more so in developing countries. HIV researchers have devised successful prevention and treatment strategies over the last two decades, yet there have been recent surges in infection in this country among specific populations, the most worrisome being that among young adults in their 20s. There is also concern about the growing incidence of drug-resistant strains of the virus affecting those in the U.S. being treated with AIDS "drug cocktails." In sub-Saharan Africa, parts of the Indian subcontinent, and southeast Asia and China, HIV is spreading rapidly and effective drugs are largely out-of-reach for the infected.

UMDNJ-New Jersey Medical School (NJMS) in Newark has been at the forefront of research on pediatric HIV infection for the past two decades. The molecular virology lab established at the school by Paul Palumbo, MD, professor of pediatrics, was instrumental in the development of PCR methodology (polymerase chain reaction, a technique for amplifying specific nucleic acids in vitro) for pediatric HIV diagnosis and monitoring. The laboratory currently focuses on unique aspects of early childhood infection. Palumbo has also been involved at a national level in establishing the direction and focus of pediatric AIDS clinical trials. He is currently Vice Chair of the Pediatric AIDS Clinical Trials Group, a unit of the National Institute for Allergy and Infectious Disease, Division of AIDS.

Palumbo's program in Newark has recently been awarded a $ 5.6 million, five-year renewal grant to continue the team's work, as well as to branch out into several newly identified priority areas. The NJMS site is one of 18 nationwide funded by the Pediatric AIDS Clinical Trials Group.

New goals outlined by the group for the upcoming funding cycle include targeting HIV-infected adolescents who have acquired the infection through adult behaviors, and focusing on international clinical trials that will aim to address pediatric questions important to those particular sites.

In Newark, Palumbo will work with adolescent medicine specialist and NJMS professor of pediatrics Robert Johnson, MD, to: identify those who are infected; provide them with the best therapies and help them adhere to drug regimens; offer them access to clinical trials; and prevent infection in non-infected, but at-risk, teens.

The international effort poses some new challenges. For example, Palumbo says, "We don't see many children in the U.S. co-infected with TB, but in Thailand, India, South Africa and Brazil, this is a real problem. It needs to be addressed." Another important goal is making treatments cheaper and more easily implemented in places with less resources. Last year, the Pediatric AIDS Clinical Trials Group funded and developed four sites abroad, two in South Africa and two in Thailand.

With the knowledge that new infections are being acquired at an alarming rate in 18-to 24-year olds, the researchers are also discussing the best age to introduce vaccines to prevent infection, when those vaccines become available, and how to develop sites for large-scale vaccine testing.

"Vaccines present a glimmer of hope that we could make our way out of this devastation," says Palumbo.