July 11, 2008
NIH Podcast Episode #0062
Balintfy: Welcome to the 62nd episode of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health--the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this episode how one of the NIH's institutes was recently renamed; and an interview from one of that institute's experts on fibroids. But first, a report on breastfeeding in preventing infant death and HIV infection in poor countries. That's next on NIH Research Radio.
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Findings Provide Insights into Breastfeeding in Preventing Infant Death, HIV Infection in Poor Countries
Balintfy: HIV and AIDS research is principally done by the National Institute of Allergy and Infectious Diseases here at NIH. But much important medical research can cross institutes. In this episode, we're focusing on work by one particular institute. Wally Akinso brings us this first report on some of it's research on HIV and AIDS.
Akinso: Two recent studies offer insights into preventing early death and HIV among breastfeeding infants of mothers with the virus in poor countries. Dr. Lynne Mofenson, is Chief of the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Pediatric, Adolescent and Maternal AIDS Branch, and the project offer for the two studies. She describes the first study.
Mofenson: The Zambia exclusive breastfeeding study enrolled 958 women who were HIV infected and their infants and randomly assigned them to two groups. In the intervention group, women were counseled to exclusively breastfeed their infants for four months not offering any formula or other liquids and then to abruptly discontinue all breastfeeding when their infants were four months old. With the thought here being that you could provide protection during a very high risk group by allowing early breastfeeding and then you would avoid the risk of HIV transmission by stopping. The women were provided with formula and instructed how to safely prepare it. And in the control group the women were advised to exclusively breastfeed for four months and then to continue breastfeeding for as long as they chose to. And then the infants were tested for HIV infection periodically throughout the study and also mortality was evaluated.
Akinso: The study found no benefit for infants when their mothers with HIV stopped breastfeeding after the first four months. In addition, the study found no difference in HIV infection rates or in death rates by age 2 among infants abruptly weaned off all breast milk at four months versus those who breast fed until later in infancy. Dr. Mofenson talks about the second study.
Mofenson: This study was conducted in Malawi. This study enrolled a little over 3,000 infants who were born to HIV infected mothers but were not infected themselves at birth and compared two extended regiments of nevirapine to the country standard treatment. And the standard treatment in this country for women who do not present until labor or are identified as infected immediately postpartum is to give a single dose of nevirapine to the mother during labor and a single dose of nevirapine to the infant at birth and then daily doses of zidovudine to the infant for the first week of life. So that's the standard for this situation of late presenting women.
Akinso: The infants were assigned at random to one of three groups. The control group received the standard treatment. The next group received the standard treatment plus nevirapine day 8 through the 14th week of life. The final group received the standard treatment plus nevirapine and zidovudine. Dr. Mofenson concluded that providing anti-HIV drugs to breastfeeding infants is the way to go.
Mofenson: So this study showed that if you give 14 weeks of extended antiretroviral drugs to the baby you can reduce the risk of HIV transmission through breast milk
Akinso: Dr. Mofenson added that in many poor countries mothers with HIV face a stark choice: to nurse their infants, and risk passing on HIV through their breast milk or to formula feed, and deprive their infants of much of the natural immunity needed to protect against fatal diseases of early infancy. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
NICHD Renamed for Eunice Kennedy Shriver
Balintfy: It was just a few months ago, that one of the 27 institutes and centers at NIH, was renamed at a ceremony on the NIH campus in Bethesda, Maryland to honor Eunice Kennedy Shriver.
Zerhouni: We're witnessing an event that is illustrative of a fundamental truth.
Balintfy: Dr. Elias Zerhouni is the Director of the NIH.
Zerhouni: History is made by a few leaders with a vision when it's embraced by all of us as a mission. And I think today, we're seeing the vision of a few leaders.
Balintfy: Members of Congress, federal officials, as well as family and friends of Mrs. Shriver at the renaming event included Senators Edward Kennedy and Orin Hatch, Congressman Steny Hoyer, and Governor Arnold Schwarzenegger. Dr. Duane Alexander, director of the newly renamed institute, highlights Mrs. Shriver's leadership.
Alexander: In Washington and elsewhere, many good ideas languish unfulfilled. That could have happened with the idea of a new institute if a champion had not come forward to bring it to fruition. That champion was Eunice Kennedy Shriver, who was passionate about improving the lives of persons with mental retardation.
Balintfy: Dr. Alexander explains that in the early 1960s, Mrs. Shriver urged her brother, President John F. Kennedy, to establish an institute that would conduct research on children's health and human development. She later worked with House and Senate leaders to help ensure passage of the legislation that would make the institute a reality. Mrs. Shriver says much, but not all of her life has been spent working to make the world a better place for people with intellectual disability.
Shriver: That has been a huge part of my life. It inspired me to work and research when we were young, to create sports programs with others, Special Olympics and Best Buddies, to ask political leaders for more education, more health care, more housing and more acceptance.
Balintfy: Again, Dr. Zerhouni:
Zerhouni: It is with the greatest pride for all of us at the National Institute of Health, to witness the change of the name of the National Institute of Child Health and Human Development to the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Balintfy: The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit www.nichd.nih.gov.
Balintfy: Coming up next, one of the other topics studied by NICHD researchers: fibroids.
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Balintfy: Uterine fibroids are the most common benign soft tissue tumors in women. Up to 77% of women have microscopic or macroscopic uterine fibroids at the time of menopause. To learn more about this condition, we talked to Dr. Alicia Armstrong, Associate investigator and staff clinician at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. We started by asking, what are fibroids?
Armstrong: Uterine fibroids are an overgrowth of the muscle in the uterus. They're benign, meaning non-cancerous, tumors.
Balintfy: Do fibroids cause symptoms?
Armstrong: They can cause multiple symptoms. The most commons symptoms are bleeding and pelvic pain and pressure.
Balintfy: What causes uterine fibroids?
Armstrong: We don't know, which is why we're interested in doing research into not only how to better treat fibroids, but what causes fibroids.
It's not something that's related to behavior or environment. It appears to be genetic. And because it's so common, there aren't a number of effective things that can be done prophylacticly.
With some illnesses, for instance with diabetes, by avoiding becoming obese you can lower your risk. With fibroids, because it is so common and because it tends to run in families, there aren't a lot of things that you can do to avoid getting fibroids.
Balintfy: Are there certain women who are more likely to get uterine fibroids?
Armstrong: Well, in terms of ethnic groups, African American women are more likely to get fibroids. The lifetime incidence for African American women is 80 percent. It's 60 percent for Caucasian women, so a very common problem among all races. It also tends to run in families, in that if someone's mother or sister had fibroids, they're at greater risk.
Balintfy: What kinds of treatments are currently available for fibroids?
Armstrong: Currently the only cure is surgical. That's why we're so excited about the research that we're doing to look at a medication, an oral drug that can help shrink fibroids. And the surgeries that are offered for fibroids, there's two. The only cure is hysterectomy, which means removing the entire uterus. Myomectomy, which is removing just the fibroids, is also a surgical treatment, but there's a chance that the fibroids can grow back, so it's not considered a cure.
Balintfy: What kind of research is being done for treating fibroids?
Armstrong: We're looking at a medication that in preliminary results has been shown to shrink the fibroids. It doesn't make them completely go away, but it does shrink the fibroids. One of the other benefits is while women are on the study drug, their periods often become much lighter or even stop, which addresses one of the major side effects, one of the major problems with fibroids, which is heavy bleeding. Now, the medication affects a hormone progesterone, and that's how it helps to shrink the fibroids, and there are very few in the way of side effects, and there haven't been any long term serious complications that have been seen with the study drug or drugs that are similar to the drug that we're using in this current investigation.
Balintfy: Who would qualify to be included the a study on fibroids?
Armstrong: Well, women between the ages of 25 and 50 who are not yet menopausal, who haven't yet gone through change of life, who have symptoms from fibroids. And as I mentioned, the most common symptoms are bleeding, pain and pressure. Most of the women that are in the study are local because it does require multiple study visits, so it's primarily women in the Washington, D.C. and Virginia and Maryland areas that are enrolled.
Balintfy: Thank you Dr. Alcia Armstrong. For more information about this study, visit fibroids.nichd.nih.gov or call is 1-800-411-1222.
Balintfy: That's it for this episode of NIH Research Radio. Please join us again on Friday, July 25th when our next edition will be available for download. I'm your host, Joe Balintfy. Thanks for listening.
NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.