Pediatric Annals

5 Questions 

A Conversation with Catherine M. Wilfert, MD

Stanford T. Shulman, MD; Catherine M. Wilfert, MD

Abstract

Dr. Shulman: Over the past 20 to 30 years, the “new morbidities” have been in the ascendant and infectious disease is no longer at the heart of pediatric medicine as it’s practiced in the office. And yet, AIDS is very much a pediatric concern worldwide. What should general practitioners know about this epidemic?

Dr. Wilfert: HIV is a great mimicker. People used to say that about syphilis. Pediatricians should be aware that HIV is a possibility if a child presents with growth failure or another unrecognizable syndrome. So, the HIV status of the mother will be very important. Was she tested during her pregnancy? If she wasn’t, then she and the child should be tested. You can almost resolve the issue if you know the mother was HIV-negative when the baby was born. Since 1994, when the science was accepted, only a few states, including Connecticut and New York, have made it mandatory for pregnant women to be tested for HIV. But most states approach it as you will be tested unless you object.

Dr. Shulman: You are credited with seeing how administering azidothymidine (AZT) to infected, pregnant women could prevent the spread of the infection to their newborns. What gave you the insight to try that?

Dr. Wilfert: The process really was very simple. There was only AZT available. It was the first antiretroviral targeting HIV. The logic went something like this: if AZT successfully suppresses the virus enough to make people feel better, then if all children of HIV-positive pregnant women actually get the drug, maybe it will keep the baby from being infected. The study was done by the AIDS clinical trial group, and I was the leader of the pediatric group. Lynne M. Mofenson, MD, was also involved. It was a revolutionary idea in that we were going to give a potential toxic drug to pregnant women. I mean, c’mon! But if it seemed to make them healthier, and protect the babies from HIV, then the greater good was being accomplished. As it turned out, there is no evidence of it being harmful to the babies as determined by comparing the babies of moms who received AZT with the babies of the placebo group.

Dr. Shulman: Who are your inspirations?

Dr. Wilfert: I have many, but two important ones include a pediatrician in Houston, Martha Yow, MD. She was an infectious disease specialist. She was a southerner who went to med school in the era when it was very unusual for women to do that. She was a very fine physician and a gentle lady. The other is John F. Enders, MD, who was the Nobel laureate I worked with in the lab with at Children’s Hospital in Boston. He was a pure a scientist with zero other motivations: if the science could benefit people, so much the better. He didn’t want to make money or be famous. He just wanted to find the answers.I think that increasingly it’s very hard to do that because you have to be competitive in order to get your work funded. He was competitive, and his work was so good he competed successfully. He always shared everything, and he always gave credit. Increasingly, people are selfish about this. I was in the lab in the mid-1960s. There was more funding available then. He always turned money back in at the end of the year.

Dr. Shulman: What drew you to work in infectious disease and pediatric virology in particular?

Dr. Wilfert: I was already a pediatrician at Boston Children’s Hospital when I got the chance to work with Drs. Katz…

Dr. Shulman: Over the past 20 to 30 years, the “new morbidities” have been in the ascendant and infectious disease is no longer at the heart of pediatric medicine as it’s practiced in the office. And yet, AIDS is very much a pediatric concern worldwide. What should general practitioners know about this epidemic?

Dr. Wilfert: HIV is a great mimicker. People used to say that about syphilis. Pediatricians should be aware that HIV is a possibility if a child presents with growth failure or another unrecognizable syndrome. So, the HIV status of the mother will be very important. Was she tested during her pregnancy? If she wasn’t, then she and the child should be tested. You can almost resolve the issue if you know the mother was HIV-negative when the baby was born. Since 1994, when the science was accepted, only a few states, including Connecticut and New York, have made it mandatory for pregnant women to be tested for HIV. But most states approach it as you will be tested unless you object.

Dr. Shulman: You are credited with seeing how administering azidothymidine (AZT) to infected, pregnant women could prevent the spread of the infection to their newborns. What gave you the insight to try that?

Dr. Wilfert: The process really was very simple. There was only AZT available. It was the first antiretroviral targeting HIV. The logic went something like this: if AZT successfully suppresses the virus enough to make people feel better, then if all children of HIV-positive pregnant women actually get the drug, maybe it will keep the baby from being infected. The study was done by the AIDS clinical trial group, and I was the leader of the pediatric group. Lynne M. Mofenson, MD, was also involved. It was a revolutionary idea in that we were going to give a potential toxic drug to pregnant women. I mean, c’mon! But if it seemed to make them healthier, and protect the babies from HIV, then the greater good was being accomplished. As it turned out, there is no evidence of it being harmful to the babies as determined by comparing the babies of moms who received AZT with the babies of the placebo group.

Dr. Shulman: Who are your inspirations?

Dr. Wilfert: I have many, but two important ones include a pediatrician in Houston, Martha Yow, MD. She was an infectious disease specialist. She was a southerner who went to med school in the era when it was very unusual for women to do that. She was a very fine physician and a gentle lady. The other is John F. Enders, MD, who was the Nobel laureate I worked with in the lab with at Children’s Hospital in Boston. He was a pure a scientist with zero other motivations: if the science could benefit people, so much the better. He didn’t want to make money or be famous. He just wanted to find the answers.I think that increasingly it’s very hard to do that because you have to be competitive in order to get your work funded. He was competitive, and his work was so good he competed successfully. He always shared everything, and he always gave credit. Increasingly, people are selfish about this. I was in the lab in the mid-1960s. There was more funding available then. He always turned money back in at the end of the year.

Dr. Shulman: What drew you to work in infectious disease and pediatric virology in particular?

Dr. Wilfert: I was already a pediatrician at Boston Children’s Hospital when I got the chance to work with Drs. Katz and Enders in infectious diseases. It was an exciting time. Antibiotics were being developed; it was becoming possible to recognize infectious viruses, and the tools were coming available to treat these infections. ID encompassed many curable illness, until HIV came along.

Dr. Shulman: What are you reading currently?

Dr. Wilfert: I read a lot of things; I like mysteries. Recently, I’ve read about the history of HeLa cells, The Immortal Life of Henrietta Lacks, by Rebecca Skloot. It was really well done. What I had not appreciated until I read the book was how it affected IRB development and the awful things that were done to people, for example, cancer cells were injected into people to see if they would cause a tumor.

Dr. Shulman: You still travel quite a bit for your work treating pediatric AIDS globally. This must get stressful sometimes. What do you like to do to relax?

Dr. Wilfert: We have the usual array of backyard birds and I love to watch them, particularly hummingbirds. I garden and I like to take pictures — I took a lot in Africa. And I love to read and to cook. I have yet to wake up and think, “What am I going to do today?”

Authors
Photo courtesy of David Jones. Reprinted with permission.

Photo courtesy of David Jones. Reprinted with permission.

Dr. Cathy Wilfert is Professor Emerita of Pediatrics and Microbiology, Duke University School of Medicine. She pioneered the use of AZT for prevention of maternal-to-infant spread of HIV perinatally, saving hundreds of thousands or even millions of lives. In the past I have told her that in her efforts in Africa to establish HIV prevention programs, she really has been doing God’s work (and I’m not very religious!).

10.3928/00904481-20121022-16

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