Article on The National AIDS Research Institute (NARI)

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HIV/AIDS IN INDIA: The National AIDS Research Institute's Long Reach

Science, Vol 304, Issue 5670, 508 , 23 April 2004

DOI: 10.1126/science.304.5670.508] Jon Cohen

PUNE--At Byramjee Jeejeebhoy Medical College, a 25-year-old HIV-

infected widow comes in to have her baby's blood tested for the

virus, part of a clinical trial she has joined that aims to prevent

transmission through breast milk. The blood samples will go across

town to the National AIDS Research Institute (NARI) for analysis.

In the city's Yerawada neighborhood of cluttered tenements and wobbly

shacks, Swamy and his staff from the Slum

Development Project provide home care, medicine, counseling, and

meals to more than 300 patients with AIDS. NARI trained much of the

staff and pays their monthly wage.

At an upstairs flat in Budhwar Peth that looks directly into the

brothels across the street, sex workers receive free health care.

NARI runs the clinic.

NARI is one of the world's only national research institutions

dedicated to HIV/AIDS, and its tentacles reach all over Pune. Its

headquarters, on a 3-hectare campus in an industrial neighborhood

outside the city, houses a staff of 60 whose labs have a DNA

sequencer to hunt for resistance mutations in HIV, polymerase chain

reaction machines, flow cytometers, and phalanxes of computers. " NARI

is the best equipped and most experienced HIV/AIDS research institute

in India, " says epidemiologist Bollinger of s Hopkins

University in Baltimore, land.

[(Photo) Relatively resource-rich. Ramesh Paranjape, NARI's officer in

charge, enjoys modern labs funded in part by the institute's

extensive collaborations.]

Bollinger had much to do with helping the institution become

established. Set up by the Indian Council of Medical Research, NARI

came to life in Pune because it could easily poach scientists from

the venerable National Institute of Virology located here. In 1992,

the nascent institute began a collaboration with Bollinger on a

project funded by the U.S. National Institutes of Health (NIH) to

prepare sites for AIDS vaccine efficacy trials. The project

ultimately fizzled out because NIH became disillusioned with the

performance of the lead vaccines in line for these trials, but the

NARI researchers got their sea legs and began to develop a detailed

understanding of the spread of HIV in Pune. " It was a huge boost for

the program, " says epidemiologist Sanjay Mehendale, NARI's deputy

director. Bollinger remains tightly linked to many NARI projects. " He

has been fantastic to collaborate with, " says NARI's leader,

immunologist Ramesh Paranjape. " We call him an honorary citizen of

Pune. "

NARI received half its $2.1 million budget this year from foreign

grants and contributions, and its work now reaches far beyond

epidemiology. A repository of Indian HIV isolates contains 190

strains. One novel study has looked for anti-HIV activity in 143

herbal preparations, which are hugely popular here. (None was found.)

In the 27 March issue of The Lancet, a study by NARI and Hopkins

researchers reported that circumcision gave men some protection from

HIV but not from other sexually transmitted diseases, suggesting that

cells in the foreskin may be extra-vulnerable to the AIDS virus. NARI

also has plugged into NIH-funded clinical trials that involve

discordant couples and vaginal microbicides (see main text). In a few

months, NARI plans to launch a study with the International AIDS

Vaccine Initiative of the first AIDS vaccine to be tested in India.

NARI has one obvious shortcoming: Its tentacles rarely stretch beyond

Pune. " As a national institution we should have reached every place, "

agrees Paranjape. " And as we get more resources, we would like to do

it. "

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