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Pediatr Infect Dis J. 2018 Oct;37(10):1016-1021. doi: 10.1097/INF.0000000000001975.

Congenital Cytomegalovirus and HIV Perinatal Transmission.

Author information

1
From the David Geffen UCLA School of Medicine, Los Angeles, CA.
2
Westat, Rockville, MD.
3
Office of the Global AIDS Coordinator, U.S. Department of State, Washington, DC.
4
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
5
Hospital Geral de Nova Iguaçu, Nova Iguaçu, RJ, Brazil.
6
Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil.
7
SAMRC and Perinatal HIV Research Unit, University of Witwatersrand, Cape Town, South Africa.
8
Stellenbosch University/Tygerberg Hospital, Cape Town, South Africa.
9
Hospital Conceicao, Porto Alegre, RS, BrazilHospital Femina, Porto Alegre, RS, Brazil.
10
Irmandade da Santa Casa de Misericordia de Porto Alegre, RS, Brazil.
11
Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
12
Ribeirão Preto Medical School, University of São Paulo, SP, Brazil.
13
Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, SP, Brazil.
14
Foundation for Maternal and Infant Health (FUNDASAMIN), Buenos Aires, Argentina.
15
Fundacao Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
16
Boston University School of Medicine, Boston, MA.

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.

PMID:
30216294
PMCID:
PMC6129438
[Available on 2019-10-01]
DOI:
10.1097/INF.0000000000001975
[Indexed for MEDLINE]

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