Postmenopausal oestrogen replacement affords cardioprotection

HIV levels may

predict mother-to-child

from a pregnant HIV-1concetration, to assess her risk of passing the virus to her infant (Proc Natl Acad Sci USA 1995; 92: 12100-04). Researchers, led by Guowei Fang, Barbara Weiser,and Harold Burger of the State of New York’s Department of Health’s Wadsworth Center in Albany, New York, measured, at the time of delivery, HIV-11 RNA in 30 HIV-infected women. Their infants were followed up for at least 6 months after birth-the age by which 100% of infections should be detectable. The eight women (27%) who transmitted the virus to their infants may be

Itwoman’s possible, plasma

among the ten with the highest plasma levels of HIV-11 RNA (190 000-1664 100 copies per mL).

were

None of the 20 mothers with lower concentrations (500-155 800 copies per mL) transmitted the virus to their infants. On the basis of statistical analysis of the distribution of the viral loads in these 30 women, the researchers projected a "threshold" for mother-to-child transmission in a larger population at a viral RNA level < 100 000 copies per mL in maternal plasma. "Women who have a viral load above the threshold have approximately a 75% probability of transmitting the virus to their infants, compared to only a 3% risk

with mothers with viral levels below the threshold", said Weiser. In addition, the researchers report that, in a preliminary study of six of the women whose HIV-1RNA concentrations had been monitored during pregnancy, viral load did not seem to change significantly in women who did not start or alter antiviral therapy. This finding suggests that measurements early in a pregnancy might be used to predict viral load at time of delivery and thus risk of mother-to-child transmission as long as there is no change in antiviral treatment. Michael

McCarthy

Postmenopausal oestrogen replacement affords cardioprotection

Postmenopausal term

longreplacement

women on

oestrogen showed significantly lower death rates than age-matched controls, according to a new study of patients enrolled in the Kaiser Permanente Medical Center in San Francisco (Obstet Gynecol 1996; 87: 6-12). Oestrogen use was associated with a 46% reduction in death risk (RR 0.54, 95% CI 038-076); most of this decline was attributable to lower mortality from coronary artery or other cardiovascular diseases. Resesearchers also found that women who took oestrogen for 15 or more years (RR for death 0-48, 95% CI 0-30-0-77) survived longer thatn did those on it for a shorter period (RR 0-69, 95% CI 0-44-1-07). Women taking the equivalent of 0-625 mg/day (mean dose) of conjugated equine oestrogen had a lower mortality than those using a higher dose. There was a tendency towards

rates of breast cancer among those on replacement (RR 1-89, 95% CI 0-43-8-36). Researchers identified 232 women born between 1900 and 1915 who began replacement therapy within 3 years of menopause and who took at least 0-3 mg of conjugated oestro-

higher

All-cause

mortality

women on

in

oestrogen

postmenopausal vs

matched

daily. Women were followed until 1993, by which time mean oestrogen use was 17 years and mean age was 77 years. Because the original focus of the study was osteoporosis, women with conditions or on medications affecting bone density were excluded; the study included only white women. The researchers pointed out that women on replacement therapy have been shown to be healthier or more likely to receive comprehensvie health care than counterparts off therapy and that lack of data on combined oestrogen-progestin may limit extrapolation of their data to current care. "Nonetheless", they conclude, "these data suggest that, for women, a longestablished, commonly used, relagens

inexpensive tively drug substantially reduce their overall of dying prematurely".

can

risk

controls Source Obstet

Gynecol 1996,

87: 6-12

David Frankel

German researchers bid for greater autonomy Association of Centres has renamed To indicate its breadth of research, it is now called the Hermann von Helmholtz Association of German Research Centres, after the researcher whose work spanned the range from physics to medicine and who is best known for inventing the ophthalmoscope. The association’s 16 research centres have an overall annual budget of about DM3 billion-90% from the federal government, and 10% from

ermany’s

Research itself.

the

respective German

state where a is situated. So far the link between the centres has been loose. Many used to focus on nuclear research but have switched in recent years to include work related to the environment or medicine. The cancer research centre (Heidelberg) has a broad programme of basic and clinicallv oriented research projects. The centre for environment and health concentrates on radiation-induced disease. The newest is the Max Delbruck Cenre centre

for Molecular Medicine (Berlin). The centres have been severely criticised for being inflexible and expensive. Some, such as the cancer centre, have countered by innovative

restructuring. The association has also established a senate, with prominent members from politics, industry, and science, in a bid for scientific kudos and stronger independence of political forces. Annette Tuffs

49