1. 06/17/09 Eunice Kennedy Shriver National Institute of Child Health and Human Development NICHD HIV Research Scientific Priorities Lynne Mofenson MD, Branch Chief Pediatric, Adolescent and Maternal AIDS Branch National Institute of Child Health and Human Development National Institutes of Health Department of Health and Human Services

2. NICHD Mission NICHD supports and conducts research on topics related to the health of children, adults, families, and populations and seeks to ensure that: –every person is born healthy and wanted; –women suffer no harmful effects from the reproductive process; and –all children reach adulthood free of disease or disability and able to fulfill their potential for a healthy and productive life.

3. NICHD HIV-Related Research Activities Since mid-1980’s, NICHD has supported studies in management and prevention of HIV in children, adolescents and women. NICHD branches involved in HIV research include: – Pediatric, Adolescent & Maternal AIDS Branch – Demographic and Behavioral Science Branch – Child Development & Behavior Branch – Endocrinology, Nutrition & Growth Branch – Contraception and Reproductive Health Branch

4. Pediatric, Adolescent and Maternal AIDS (PAMA) Branch Mission PAMA branch mission is to support and conduct domestic and international research into the –epidemiology; –clinical manifestations; –pathogenesis; –transmission; –treatment; and –prevention of HIV infection and its complications in infants, children, adolescents, pregnant/non-pregnant women, and the family unit as a whole.

5. PAMA Branch: Perinatal HIV Research Examples  Basic science, epidemiology and clinical trials research on prevention of mother to child transmission, particularly through breastfeeding.  Basic science and epidemiologic studies of short and long-term effects of in utero and neonatal antiretroviral exposure.  Studies of effects of antiretrovirals used for prevention of transmission on maternal health and health of infants who become infected despite prophylaxis.

6. PAMA Branch: Pediatric HIV Research Examples  Basic research and clinical trials on management and treatment of HIV and complications of HIV.  Studies of the effect of HIV and effects of chronic therapy on HIV-infected children as they grow older.  Studies to improving the diagnosis and management of coinfections prevalent in HIV-infected children and women in developing countries.

7. PAMA Branch: Adolescent HIV Research Examples  Clinical trials for optimization of HIV treatment in adolescents including interventions to improve treatment adherence, care and management.  Primary prevention studies, including HIV vaccines and microbicides in HIV at-risk youth.  Behavioral research on prevention of HIV in at-risk youth and modifying behavior in HIV-infected youth.

8. PAMA Branch: Women HIV Research Examples  Studies to evaluate natural history of HIV, it complications and coinfections in women in the antiretroviral era.  Research on gender specific aspects of HIV and HIV treatment (e.g., interaction of hormonal contraceptives with antiretroviral drugs).  Microbicide research to evaluate safety and efficacy of microbicides to prevent HIV transmission.

9. Demographic and Behavioral Sciences (DBS) Branch DBS branch mission is to improve health and well- being of individuals, families, and populations by adding to knowledge about human population dynamics and their causes and consequences. –Research on population diversity and change, and the consequences of such for health and well-being. –Research on the interrelationships among individual, family, group, community, and population processes. –Supports research training &infrastructure in the population sciences.

10. DBS Branch: Some Specific Areas of HIV Research Interest Sexual and risky behavior viewed on a population basis. Interrelationships among social, institutional, economic, and cultural contexts and sexual behavior. Interrelationships among pregnancy, pregnancy prevention, and HIV/STD prevention. Social, demographic, economic, or other structural impacts of HIV/STD in populations.

11. DBS Branch : Some Specific Areas of HIV Research Interest Implications of patterns of sexual behavior, testing, and treatment in populations for the spread of HIV. Intervention studies to modify HIV risk behavior based on demographic, social, and behavioral aspects of HIV sexual transmission. Develop and improve demographic methods for studying sexual behavior.

12. Endocrinology, Nutrition and Growth (ENG) Branch ENG mission is on research and training in nutritional science, childhood antecedents of adult disease, developmental endocrinology, and physical growth and body composition, including bone health and obesity. –Nutritional relationship between mother and fetus and human milk contributions to optimal nutrition. –Effects of nutrition on the adolescent growth spurt, the onset of puberty. –Etiology, consequences, and prevention of obesity and hyperlipidemia in childhood and adolescence. –Interaction of nutrition and infectious diseases.

13. ENG Branch: Some Specific Aspect of HIV Research Interest Impact of nutrition on HIV disease progression. Interaction between infant feeding practices and susceptibility to HIV infection. The role of human milk, ontogeny of human microbiome, gut integrity and probiotics. Impact nutrition on antiretroviral drug metabolism and impact of drugs on nutrition. Impact of nutrition on clinical management of side effects of antiretroviral therapy.

14. ENG Branch: Some Specific Aspect of HIV Research Interest Interactions of nutrition, HIV, and susceptibility to and treatment of co-morbidities (TB, malaria, etc). Best practices for feeding infants born to HIV- infected mothers. Examples of recent RFAs: RFA HD06-012 “Nutrition and Prevention, Care, and Treatment of HIV/AIDS” RFA HD07-001 “Integration of Food and Nutrition into Prevention, Care, and Treatment of HIV Infection and AIDS”

15. Child Development and Behavior (CDB) Branch CDB HIV-related research focuses on behavioral and developmental aspects of health and health-related behaviors in the pediatric population, which extends from infancy to young adulthood. –Risk behaviors (e.g. sexual activity, drug abuse, violence). –Academic underachievement/school dropout. –Health literacy and health communication. –Positive youth development as a means to reduce HIV risk behaviors. –Health promotion and disease prevention.

16. CRH supports research and research training programs in reproductive health, epidemiology and contraceptive technology. HIV-related research includes: –Development of microbicides, especially with contraceptive activity. –Contraceptive efficacy trials of spermicidal microbicides. –Colopscopy and optimal coherence tomography to evaluate vaginal lesions with microbicides. –Hormonal contraception and effects in preventing or enhancing heterosexual HIV and STI transmission. –Safety and efficacy of contraceptives and infertility treatments in HIV-positive women. Contraceptive and Reproductive Health (CRH) Branch

17. NICHD International Extramural Associates Research Development Awards (I-EARDA) Goal: To develop grant administrative capacity at research institutions in developing countries to facilitate and/or develop the appropriate administrative structure to support biomedical and behavioral research capacity and activities. Format: Distance learning and a 2-part NIH residency program, as well as funding to augment administrative infrastructure. Innovations: Focuses on training grants managers, as opposed to researchers. URL: http://grants.nih.gov/grants/guide/pa- files/PAR-07-431.html

18. NICHD HIV Research Contact Information  Pediatric, Adolescent & Maternal AIDS Branch: Lynne M. Mofenson: LM65D@nih.gov  Demographic and Behavioral Science Branch: Susan Newcomer: newcomes@mail.nih.gov  Child Development & Behavior Branch: Lynne Haverkos: haverkol@mail.nih.gov  Endocrinology, Nutrition & Growth Branch: Dan Raiten: raitend@mail.nih.gov  Contraception and Reproductive Health Branch: Trent MacKay: mackayt@mail.nih.gov  I-EARDA Program: Regina James: rjames@mail.nih.gov

19. Thank You For Your Attention