The Multicenter AIDS Cohort Study (MACS), a long-term study of HIV and AIDS in more than 5,000 gay and bisexual men, will receive funds from the National Institute of Allergy and Infectious Diseases (NIAID) on April 1, 1995, to establish two state-of-the-art laboratories, and renew the four clinical sites and data center. First-year funding of the four-year grants together totals $6.2 million.
The MACS is one of the longest and most rigorous epidemiologic studies of HIV infection in the world," says Anthony S. Fauci, M.D., director of NIAID. "The MACS biological specimens and database, with more than a decade of valuable HIV-related information, are exceptional resources for advancing HIV and AIDS treatment and prevention strategies worldwide."
The new laboratories will bring together scientists with expertise in immunology, virology and molecular biology to study the factors that contribute to the progression of HIV disease and destruction of the immune system as well as those factors that may prevent or protect against HIV disease progression, notes Lewis K. Schrager, M.D., the project officer of MACS. Dr. Schrager is the chief of the Epidemiology Branch of the Basic Sciences Program in the NIAID Division of AIDS.
MACS directors and the four clinical sites are: Alfred Saah, M.D., M.P.H., at the Johns Hopkins School of Public Health in Baltimore; John Phair, M.D., at the Howard Brown Memorial Clinic/Northwestern University in Chicago; Roger Detels, M.D., M.S., at the University of California, Los Angeles (UCLA); and Charles Rinaldo, Ph.D., at the University of Pittsburgh.
The new MACS pathogenesis research laboratories are at Johns Hopkins, directed by Joseph Margolick, M.D., Ph.D., and at UCLA, directed by Janis Giorgi, Ph.D. The Center for the Analysis and Management of MACS Data, at Johns Hopkins, is directed by Alvaro Munoz, Ph.D.
MACS focuses on HIV disease and related infections, immune responses to the virus and the impact of anti-HIV treatments. MACS accomplishments and findings include the following: * Identification of more than 60 HIV-infected men who are long-term non-progressors, many of whom have served as critical sources of information on this phenomenon in studies conducted at several U.S. laboratories. * Prevention of Pneumocystis carinii pneumonia can delay the first AIDS-defining illness by six to 12 months. * Zidovudine (AZT) therapy given with acyclovir may significantly increase survival of AIDS patients. * The response of CD4+ T cells to AZT predicts AIDS-free time and survival among HIV-infected patients. For example, increases in CD4+ T cell counts after patients begin AZT therapy correlate to longer times to AIDS and death. * Risk factors for AIDS-related dementia include anemia, lower body mass, older age and having such symptoms as fever, fatigue, diarrhea or thrush before an AIDS diagnosis. * Symptoms of depression do not independently predict poorer outcomes to HIV infection.
Begun in 1983, MACS enrolled its first participants in 1984. Of the 5,579 men who entered the study, 2,191 were infected with HIV. During the study, 488 men have become HIV infected. The men come to the clinical sites twice a year for exams and laboratory testing as well as to answer questions about any preventive and treatment medications they take. Since enrollment, 1,362 men have developed AIDS, of whom 1,158 have died. Another 101 HIV-infected men died, but before they developed AIDS.
At enrollment, MACS men included 83.1 percent whites, 10.1 percent African Americans, 5.3 percent Hispanics, while the rest were from other or unknown racial groups. The men ranged in age from 18 to 70, and more than half had college degrees when they entered the study.
MACS collaborations with the National Cancer Institute (NCI) and the Agency for Health Care Policy and Research (AHCPR) have supported studies on HIV-related cancers and the impact of treatments on patients' use of health services.
NIAID and NCI are components of the National Institutes of Health (NIH) and support investigators and scientific studies at universities, medical schools, hospitals and research institutions in the United States and abroad. NIH and AHCPR are agencies of the U.S. Public Health Service, part of the U.S. Department of Health and Human Services.