Dr. Fauci’s presentations are always scrutinized, dissected, and sliced by the anxious basic and clinical researcher trying to read the tea leaves of future funding trends.

He discussed the HIV research priorities of the DAIDS and the NIH, and noted that research in pathogenesis will focus on achieving a better understanding of the interactions between HIV and its host, including host genetics, the early events during the establishment of HIV infection, persistency, and the role of chronic inflammation in HIV disease progression.

There have been huge advances over the last 20 years in the area of therapeutics, with 25 approved drugs, that have resulted in dramatic improvements in the quality and quantity of life of HIV infected individuals. However, Dr. Fauci lamented that those improvements have been implemented mainly in the developed nations, and noted that the situation is improving in the developing world, with approximately 4 million people receiving antiretroviral treatment thanks to programs like PEPFAR, the Global fund and the contributions of many NGOs and philanthropists. These outcomes are promising, but still represent only a small fraction of the total need. The trend to treat people earlier in the course of their disease will only accentuate the dichotomy between the rich and the poor.

Prevention is another research priority. In spite of all the improvements in therapeutics, he noted that the numbers of new cases of HIV in the US has stabilized with no improvement in 10 years at around 50,000 a year. The NIH will promote proven strategies to prevent the extension of this devastating disease, including needle exchange programs and the use of condoms, which were not favorites of the previous administration. New strategies being evaluated include treatment of co-infections, pre-exposure prophylaxis for high risk individuals, universal voluntary testing and treatment and preventive vaccines, where the focus is going to shift from development to discovery. Fauci concluded with a brief outline of the HIV goals and policies of the Obama administration.

The second talk was given by Dr. Goosby, the new director of the PEPFAR, who has been in this position for only 3 weeks. He suggested that the new administration will be building new partnerships with governments in addition to directly distributing funds to particular groups or NGOs within countries, and that priority will be given to scientifically based sound interventions, including needle exchange programs and programs that promote the use of condoms.