Cytomegalovirus Urinary Shedding in HIV-infected Pregnant Women and Congenital Cytomegalovirus Infection
Kristina Adachi, Jiahong Xu, Bonnie Ank, D Heather Watts, Lynne M Mofenson, Jose Henrique Pilotto, Esau Joao, Breno Santos, Rosana Fonseca, Regis Kreitchmann, Jorge Pinto, Marisa M Mussi-Pinhata, Glenda Gray, Gerhard Theron, Mariza G Morgado, Yvonne J Bryson, Valdilea G Veloso, Jeffrey D Klausner, Jack Moye, Karin Nielsen-Saines, NICHD HPTN 040 Study Team, Mariana Ceriotto, Edgardo Szyld, Silvia Marzo, Flavia Faleiro Ferreira, Fabiana Kakehasi, Rita Lira, Carla Franceschini de Fraga, Rita Lira, Debora Fernandes Coelho, Alberto Sanseverino, Luis Carlos Ribeiro, M Leticia Santos Cruz, Ezequias Martins, Jacqueline Anita de Menezes, Luisa Andrea Torres Salgado, Ana Valeria Cordovil, Andréa Gouveia, Priscila Mazzucanti, Jorge Eurico Ribeiro, Geraldo Duarte, Adriana Aparecida Tiraboschi Barbaro, Carolina Sales Vieira, Daisy Maria Machado, Regina Succi, Mark Cotton, Jeanne Louw, Elke Maritz, Sarita Lalsab, Shini Legoete, James Alasdair McIntyre, Mandisa Nyati, Allison Agwu, Jean Anderson, Joan Bess, Jonathan Ellen, Todd Noletto, Nancy Hutton, Carol Delany, Robert M Lawrence, Chas Griggs, Mobeen Rathore, Kathleen Thoma, Michelle Tucker, Audra Deveikis, Susan Marks, Linda Bettica, James M Oleske, Midnela Acevedo Flores, Elvia Pérez, Francisco I Bastos, Beatriz Grinsztejn, Ronaldo I Moreira, Marilia Santini de Oliveira, Monica Derrico, Valéria Ribeiro, Thiago Torres E Fiotec, Ruth Dickover, Margaret Camarca, James Bethel, Emmanuel Aluko, Yolanda Bertucci, Jennifer Bryant, Patty Chen, Barbara Driver, Ruby Duston, Adriana Ferreira, Priya Guyadeen, Sarah Howell, Marsha Johnson, Linda Kaufman, Naomi Leshabane, Lilya Meyerson, Rita Patel, Lubima Petrova, Georgine Price, Susan Raitt, Scott Watson, Yiling Xu, Eunice Yu, George Siberry, Jennifer Read, Elizabeth Smith, Sheryl Zwerski, Kristina Adachi, Jiahong Xu, Bonnie Ank, D Heather Watts, Lynne M Mofenson, Jose Henrique Pilotto, Esau Joao, Breno Santos, Rosana Fonseca, Regis Kreitchmann, Jorge Pinto, Marisa M Mussi-Pinhata, Glenda Gray, Gerhard Theron, Mariza G Morgado, Yvonne J Bryson, Valdilea G Veloso, Jeffrey D Klausner, Jack Moye, Karin Nielsen-Saines, NICHD HPTN 040 Study Team, Mariana Ceriotto, Edgardo Szyld, Silvia Marzo, Flavia Faleiro Ferreira, Fabiana Kakehasi, Rita Lira, Carla Franceschini de Fraga, Rita Lira, Debora Fernandes Coelho, Alberto Sanseverino, Luis Carlos Ribeiro, M Leticia Santos Cruz, Ezequias Martins, Jacqueline Anita de Menezes, Luisa Andrea Torres Salgado, Ana Valeria Cordovil, Andréa Gouveia, Priscila Mazzucanti, Jorge Eurico Ribeiro, Geraldo Duarte, Adriana Aparecida Tiraboschi Barbaro, Carolina Sales Vieira, Daisy Maria Machado, Regina Succi, Mark Cotton, Jeanne Louw, Elke Maritz, Sarita Lalsab, Shini Legoete, James Alasdair McIntyre, Mandisa Nyati, Allison Agwu, Jean Anderson, Joan Bess, Jonathan Ellen, Todd Noletto, Nancy Hutton, Carol Delany, Robert M Lawrence, Chas Griggs, Mobeen Rathore, Kathleen Thoma, Michelle Tucker, Audra Deveikis, Susan Marks, Linda Bettica, James M Oleske, Midnela Acevedo Flores, Elvia Pérez, Francisco I Bastos, Beatriz Grinsztejn, Ronaldo I Moreira, Marilia Santini de Oliveira, Monica Derrico, Valéria Ribeiro, Thiago Torres E Fiotec, Ruth Dickover, Margaret Camarca, James Bethel, Emmanuel Aluko, Yolanda Bertucci, Jennifer Bryant, Patty Chen, Barbara Driver, Ruby Duston, Adriana Ferreira, Priya Guyadeen, Sarah Howell, Marsha Johnson, Linda Kaufman, Naomi Leshabane, Lilya Meyerson, Rita Patel, Lubima Petrova, Georgine Price, Susan Raitt, Scott Watson, Yiling Xu, Eunice Yu, George Siberry, Jennifer Read, Elizabeth Smith, Sheryl Zwerski
Abstract
Background: Cytomegalovirus (CMV) urinary shedding in pregnant women infected with human immunodeficiency virus (HIV) was evaluated to determine whether it poses an increased risk for congenital CMV infection (cCMV).
Methods: A subset of mother-infant pairs enrolled in the perinatal NICHD HPTN 040 study (distinguished by no antiretroviral use before labor) was evaluated. Maternal and infant urines were tested by qualitative real-time polymerase chain reaction (RT-PCR) for CMV DNA with quantitative RT-PCR performed on positive specimens.
Results: Urine specimens were available for 260 women with 85.4% from the Americas and 14.6% from South Africa. Twenty-four women (9.2%) had detectable CMV viruria by qualitative PCR. Maternal CMV viruria was not associated with mean CD4 cell counts or HIV viral load but was associated with younger maternal age (P = .02). Overall, 10 of 260 infants (3.8%) had cCMV. Women with detectable peripartum CMV viruria were more likely to have infants with cCMV than those without: 20.8% (5/24) versus 2.1% (5/236), (P = .0001). Women with CMV viruria had significantly higher rates of HIV perinatal transmission (29.2% vs. 8.1%, P = .002). They were 5 times (adjusted odds ratio [aOR] = 5.6, 95% confidence interval [CI] 1.9-16.8) and nearly 30 times (aOR, 29.7; 95% CI, 5.4-164.2) more likely to transmit HIV and CMV to their infants, respectively. Maternal gonorrhea (aOR, 19.5; 95% CI, 2.5-151.3) and higher maternal HIV log10 viral load (OR, 2.8; 95% CI, 1.3-6.3) were also significant risk factors for cCMV.
Conclusion: In this cohort of HIV-infected pregnant women not on antiretrovirals, urinary CMV shedding was a significant risk factor for CMV and HIV transmission to infants.
Clinical trials registration number: NCT00099359.
Keywords: CMV viruria; HIV; HIV perinatal transmission; congenital CMV; pregnancy.
© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com
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Source: PubMed