Congenital Cytomegalovirus and HIV Perinatal Transmission

• Published in: The Pediatric infectious disease journal Vol. 37; no. 10; pp. 1016 - 1021
• Main Authors: 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, Nielsen-Saines, Karin
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-10-2018
• Subjects: Anti-Retroviral Agents - therapeutic use; Cohort Studies; Cytomegalovirus; Cytomegalovirus Infections - congenital; Cytomegalovirus Infections - etiology; DNA, Viral - urine; Female; HIV Infections - complications; HIV Infections - transmission; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Pregnancy; Pregnancy Complications, Infectious - virology; Real-Time Polymerase Chain Reaction; Risk Factors; Viral Load
• ISSN: 0891-3668; 1532-0987; 1532-0987
• DOI: 10.1097/INF.0000000000001975

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% CI2.3–8.2) and 6-fold greater among HIV in utero–infected infants (adjusted OR, 6; 95% CI3–12.1) 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.