Congenital Cytomegalovirus and HIV Perinatal Transmission.
Adachi, Kristina MD *; Xu, Jiahong MS, MPH +; Ank, Bonnie BA *; Watts, D. Heather MD ++; Camarca, Margaret RN, MPH +; Mofenson, Lynne M. MD [S]; Pilotto, Jose Henrique MD [P]; Joao, Esau MD ||; Gray, Glenda MD **; Theron, Gerhard MD ++; Santos, Breno MD ++++; Fonseca, Rosana MD [S][S]; Kreitchmann, Regis MD [P][P]; Pinto, Jorge MD ||||; Mussi-Pinhata, Marisa M. MD ***; Machado, Daisy Maria MD +++; Ceriotto, Mariana MD ++++++; Morgado, Mariza G. PhD [S][S][S]; Bryson, Yvonne J. MD *; Veloso, Valdilea G. MD [S][S][S]; Grinsztejn, Beatriz MD, PhD [S][S][S]; Mirochnick, Mark MD [P][P][P]; Moye, Jack MD [S]; Nielsen-Saines, Karin MD *; MPH for the NICHD HPTN 040 Study Team
Pediatric Infectious Disease Journal.
37(10):1016-1021, October 2018.
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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.
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