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NEW ORGANIZATION HMS Division of AIDS Created to Speed Research HMS researchers have made some of the most important advances against HIV and AIDS in the 20 years since the epidemic began. But until now, they have not had a common institutional base within the School. Bruce Walker is director of the new HMS Division of AIDS, which brings AIDS and HIV researchers from the School and affiliates together under one umbrella. Photo by Jeff Thiebeauth The new HMS Division of AIDS will provide that home and will enhance coordination, spur collaboration, and open up new avenues for research funding, its leaders say. The HMS Record Against AIDS HIV/AIDS researchers at HMS have: Demonstrated a marked decrease in CD4+ T cells in AIDS patients, establishing a basis for the impairment of the immune system in the disease; Made the first clinical description of an AIDS-like illness in monkeys and demonstrated AIDS transmission in monkeys; First isolated HIV from semen, providing critical support for the theory that HIV is sexually transmitted; First demonstrated in vitro that combination antiretroviral therapy is more effective than single-drug therapy in reducing HIV replication; Created the first animal model to study how HIV damages the fetal immune system and how prenatal and perinatal transmission of the virus from mother to child can be prevented; Established the critical role of HIV-1-specific T helper cells in protecting against disease progression; Obtained the crystal structure of the HIV-1 gp120 envelope protein, resulting in 3-D pictures that reveal how HIV-1 attaches to white blood cells and evades the host immune system; Demonstrated that early treatment of acute HIV infection augments immune function and allows for spontaneous immune control of the virus after treatment cessation in some patients; Performed the first effective vaccination in monkeys against a strong virus challenge, giving insight into protective immune responses; and Established the cost-effectiveness of highly active antiretroviral therapy (HAART). "Harvard Medical School has made tremendous contributions to dealing with the HIV epidemic, but we all believe we can do much better still," said Bruce Walker, HMS professor of medicine at Massachusetts General Hospital and the division's first director. "The Division of AIDS is a way to help coordinate an accelerated effort to address this global health crisis." Division Adds Up All investigators at the School and affiliated institutions who have funding for basic or clinical research related to HIV and AIDS from the NIH or other peer-reviewed sources will be considered members. This group currently numbers 165 faculty with $75 million annually in sponsored research funding. The division will combine two existing NIH-funded Centers for AIDS Research already based at HMS and the affiliates into one larger unit. The AIDS Clinical Trial Unit and the HIV Vaccine Clinical Trial Unit (see Focus, April 20, 2001) will also become part of the division. To preserve the collaborative spirit that guided the division's creation, leadership will rotate among the participating institutions every two years. When Walker's term is up in 2003, associate director Joseph Sodroski, HMS professor of pathology at the Dana-Farber Cancer Institute, is slated to succeed him as director. "The Division of AIDS will strengthen interactions among the incredibly accomplished group of AIDS researchers at Harvard Medical School," Sodroski said. "I'm optimistic that these collective efforts will hasten the end of this tragic epidemic." Raphael Dolin, dean for clinical programs, helped to establish the division and serves as the Dean's Office liaison to the group. He said that until now, many HMS AIDS researchers "were collaborating at a considerable distance, when they had equal or greater opportunities within the Harvard medical community. This is a way to bring them together." Credit History Walker emphasized what he called the "stunning" list of advances the School's faculty have made against HIV. For example, "The key immune responses that are thought to be important for vaccine development were all discovered at Harvard Medical School--neutralizing antibodies, cytotoxic T cells, and T helper cells and their role in AIDS pathogenesis," he said. "What we're trying to do now as a division is to build on these and many other advances." Walker's own research showed that treating patients very early in the acute phase of HIV infection can change the way their immune system sees the virus, induce strong helper T cell responses and, in some cases, get them off medicine and allow them to control the virus on their own. Particularly crucial to advancing current treatments, Walker said, will be the division's ability to bring basic and clinical scientists into close working relationships. "Because we're seeing clinical manifestations of the disease, we're able to think about the important biological questions in a different way than someone who is working in basic science totally divorced from the clinical front." The division will foster interinstitutional collaboration in education and outreach as well as research, Dolin said, and it is meant to complement the HSPH-based Harvard AIDS Institute, with which collaborations are planned. A fund-raising component to the division is also anticipated. "There are a lot of people interested in contributing to the fight against AIDS, and we think the opportunity to contribute to the entire Harvard program will be attractive to potential donors," Dolin said. A major goal will be to raise the resources needed to build "the best HIV research center in Africa," in one of the areas hardest-hit by the epidemic, Walker said. The center is envisioned as a training ground for Africans who aspire to becoming AIDS researchers and as a platform for studies of antiviral therapy in resource-poor settings. --Tom Reynolds