Acute cytomegalovirus infection in Kenyan HIV-infected infants

Abstract

Objective Cytomegalovirus (CMV) coinfection may influence HIV-1 disease progression during infancy. Our aim was to describe the incidence of CMV infection and the kinetics of viral replication in Kenyan HIV-infected and HIV-exposed uninfected infants. Methods HIV-1 and CMV plasma viral loads were serially measured in 20 HIV-exposed uninfected and 44 HIV-infected infants born to HIV-infected mothers. HIV-infected children were studied for the first 2 years of life, and HIV-exposed uninfected infants were studied for 1 year. Results CMV DNA was detected frequently during the first months of life; by 3 months of age, CMV DNA was detected in 90% of HIV-exposed uninfected infants and 93% of infants who had acquired HIV-1 in utero. CMV viral loads were highest in the 1–3 months following the first detection of virus and declined rapidly thereafter. CMV peak viral loads were significantly higher in the HIV-infected infants compared with the HIV-exposed uninfected infants (mean 3.2 versus 2.7 log10 CMV DNA copies/ml, respectively, P = 0.03). The detection of CMV DNA persisted to 7–9 months post-CMV infection in both the HIV-exposed uninfected (8/17, 47%) and HIV-infected (13/18, 72%, P = 0.2) children. Among HIV-infected children, CMV DNA was detected in three of the seven (43%) surviving infants tested between 19 and 21 months post-CMV infection. Finally, a strong correlation was found between peak CMV and HIV-1 viral loads (ρ = 0.40, P = 0.008). Conclusion Acute CMV coinfection is common in HIV-infected Kenyan infants. HIV-1 infection was associated with impaired containment of CMV replication.

Prevalence and risk factors of cytomegalovirus infection among HIV-infected and HIV-exposed uninfected infants in Nigeria

“…These values were lower than the prevalence of 93% among HIV-infected and the 90% among the HEU Kenyan infants at three months of age found in another study [15]. Also, the CMV prevalence of 41.4% in this study was higher than the respective 23.8% and 38.6% reported among Bulgarian [29] and Brazilian [30] hospitalized children of similar ages.…”

“…In addition, the prevalence of acute CMV infection in this study was higher than the 15%-20% among HEU children [16] but lower than the 30%-40% among the HIV-infected children in the United States cohorts at six months of age [13]. The differences in the geographical locations and ethnicities, the varying socioeconomic conditions, differences in normative practices of breastfeeding, the diverse age at CMV diagnosis, the HIV status state, the different definitions ascribed to CMV diagnosis, and the differing risks of postnatal transmission of CMV that were found in our setting and those of others could explain the dissimilarities in the prevalence of CMV observed in our study and in those of others [2,3,13,15,16]. In this study, we defined acute CMV infection as infants who were CMV IgM positive at three months of age.…”

“…Fortunately, CMV acquisition had been noted to peak in sub-Saharan HIV-exposed and HIV-infected infants at three to four months of age [15,44].…”

“…In Africa, few studies on CMV in pediatric populations have been done in The Gambia [5], Kenya [15], Zambia [18], and Ivory Coast [19], with none known to the researchers in Nigeria of HIV-infected or HEU children who are at risk of the aforementioned complex interactions.…”

“…Complex interactions exist between HIV and CMV, including a shared mode of in utero, perinatal, and post-natal routes of transmission [11][12][13][14]; a higher rate of congenital CMV infection in HIV-infected infants [11][12][13][14]; an impaired containment of CMV replication among HIV-infected infants [15]; and a more severe course of HIV infection, accompanied by a higher rates of central nervous system complications [16]. Mortality is also higher in CMV-HIV co-infected infants [17], and poorer growth and development had been recorded even among HIVexposed uninfected (HEU) infants who were coinfected with CMV [18].…”