Congenital Cytomegalovirus and HIV Perinatal Transmission
Kristina Adachi, Jiahong Xu, Bonnie Ank, D Heather Watts, Margaret Camarca, Lynne M Mofenson, Jose Henrique Pilotto, Esau Joao, Glenda Gray, Gerhard Theron, Breno Santos, Rosana Fonseca, Regis Kreitchmann, Jorge Pinto, Marisa M Mussi-Pinhata, Daisy Maria Machado, Mariana Ceriotto, Mariza G Morgado, Yvonne J Bryson, Valdilea G Veloso, Beatriz Grinsztejn, Mark Mirochnick, Jack Moye, Karin Nielsen-Saines, MPH for the NICHD HPTN 040 Study Team, Kristina Adachi, Jiahong Xu, Bonnie Ank, D Heather Watts, Margaret Camarca, Lynne M Mofenson, Jose Henrique Pilotto, Esau Joao, Glenda Gray, Gerhard Theron, Breno Santos, Rosana Fonseca, Regis Kreitchmann, Jorge Pinto, Marisa M Mussi-Pinhata, Daisy Maria Machado, Mariana Ceriotto, Mariza G Morgado, Yvonne J Bryson, Valdilea G Veloso, Beatriz Grinsztejn, Mark Mirochnick, Jack Moye, Karin Nielsen-Saines, MPH for the NICHD HPTN 040 Study Team
Abstract
Background: Congenital cytomegalovirus (CMV) infection (cCMV) is an important cause of hearing loss and cognitive impairment. Prior studies suggest that HIV-exposed children are at higher risk of acquiring cCMV. We assessed the presence, magnitude and risk factors associated with cCMV among infants born to HIV-infected women, who were not receiving antiretrovirals during pregnancy.
Methods: cCMV and urinary CMV load were determined in a cohort of infants born to HIV-infected women not receiving antiretrovirals during pregnancy. Neonatal urines obtained at birth were tested for CMV DNA by qualitative and reflex quantitative real-time polymerase chain reaction.
Results: Urine specimens were available for 992 (58.9%) of 1684 infants; 64 (6.5%) were CMV-positive. Mean CMV load (VL) was 470,276 copies/ml (range: < 200-2,000,000 copies/ml). Among 89 HIV-infected infants, 16 (18%) had cCMV versus 42 (4.9%) of 858 HIV-exposed, uninfected infants (P < 0.0001). cCMV was present in 23.2% of infants with in utero and 9.1% infants with intrapartum HIV infection (P < 0.0001). Rates of cCMV among HIV-infected infants were 4-fold greater (adjusted OR, 4.4; 95% CI: 2.3-8.2) and 6-fold greater among HIV in utero-infected infants (adjusted OR, 6; 95% CI: 3-12.1) compared with HIV-exposed, uninfected infants. cCMV was not associated with mode of delivery, gestational age, Apgar scores, 6-month infant mortality, maternal age, race/ethnicity, HIV viral load or CD4 count. Primary cCMV risk factors included infant HIV-infection, particularly in utero infection.
Conclusion: High rates of cCMV with high urinary CMV VL were observed in HIV-exposed infants. In utero HIV infection appears to be a major risk factor for cCMV in infants whose mothers have not received combination antiretroviral therapy in pregnancy.
Trial registration: ClinicalTrials.gov NCT00099359.
Conflict of interest statement
Financial Disclosure: The authors have no financial relationships relevant to this article to disclose.
Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose.
Source: PubMed