1. Congenital Cytomegalovirus and HIV Perinatal Transmission
- Author
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Adachi, Kristina, Xu, Jiahong, Ank, Bonnie, Watts, D Heather, Camarca, Margaret, Mofenson, Lynne M, Pilotto, Jose Henrique, Joao, Esau, Gray, Glenda, Theron, Gerhard, Santos, Breno, Fonseca, Rosana, Kreitchmann, Regis, Pinto, Jorge, Mussi-Pinhata, Marisa M, Machado, Daisy Maria, Ceriotto, Mariana, Morgado, Mariza G, Bryson, Yvonne J, Veloso, Valdilea G, Grinsztejn, Beatriz, Mirochnick, Mark, Moye, Jack, and Nielsen-Saines, Karin
- Subjects
Reproductive Medicine ,Medical Microbiology ,Biomedical and Clinical Sciences ,HIV/AIDS ,Pediatric ,Perinatal Period - Conditions Originating in Perinatal Period ,Pediatric AIDS ,Clinical Research ,Infectious Diseases ,Conditions Affecting the Embryonic and Fetal Periods ,Aetiology ,2.2 Factors relating to the physical environment ,Infection ,Reproductive health and childbirth ,Good Health and Well Being ,Anti-Retroviral Agents ,Cohort Studies ,Cytomegalovirus ,Cytomegalovirus Infections ,DNA ,Viral ,Female ,HIV Infections ,Humans ,Infant ,Infant ,Newborn ,Infectious Disease Transmission ,Vertical ,Pregnancy ,Pregnancy Complications ,Infectious ,Real-Time Polymerase Chain Reaction ,Risk Factors ,Viral Load ,congenital CMV ,HIV MTCT ,HIV perinatal transmission ,MPH for the NICHD HPTN 040 Study Team ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Pediatrics ,Clinical sciences ,Paediatrics - Abstract
BackgroundCongenital 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.MethodscCMV 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.ResultsUrine 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.ConclusionHigh 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.
- Published
- 2018