Birth Prevalence of Congenital Cytomegalovirus Among Infants of HIV-Infected Women on Prenatal Antiretroviral Prophylaxis in South Africa

Manicklal, Sheetal; Niekerk, A. M. Van; Kroon, Steve; Hutto, Cecelia; Novák, Zdeněk; Pati, Sunil; Chowdhury, Nazma; Hsiao, Nei-Yuan; Boppana, Suresh B.

doi:10.1093/cid/ciu096

Cited by 55 publications

(58 citation statements)

References 17 publications

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“…However, 5 recent studies shed some light on this question and met the criteria to be included in this review [12, 20, 23–25]. The large French Perinatal Cohort Study showed lower rates of congenital CMV infection in HIV-exposed-uninfected infants in the cART era (1.2%), compared with the pre-cART era (3.5%), particularly if cART began in the first trimester ( P = .004); among HIV-infected infants, however, rates of congenital CMV infection remained high in the cART era [24].…”

Section: Resultsmentioning

confidence: 99%

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Cytomegalovirus Infection in Human Immunodeficiency Virus (HIV)–Exposed and HIV-Infected Infants: A Systematic Review

2015

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Cytomegalovirus is highly prevalent worldwide and an important opportunistic pathogen in human immunodeficiency virus (HIV)–infected individuals. The effects of cytomegalovirus infection on HIV-exposed infants are poorly understood. We conducted a systematic review to assess the relationship between cytomegalovirus and HIV infections among HIV-exposed infants. Limited evidence suggests that HIV-induced immunosuppression in the mother increases the rate of congenital cytomegalovirus infection, while maternal antiretroviral therapy may reduce it. Limited information exists on the direction of the relationship between cytomegalovirus and HIV transmission among HIV-exposed infants. Only 2 studies have addressed this temporal sequence of events, and they suggest that cytomegalovirus can lead to subsequent HIV infection in HIV-exposed infants. Most evidence suggests that early cytomegalo-virus infection accelerates HIV disease progression in infants. Gaps remain in understanding the role that cytomegalovirus infection plays in HIV-exposed infants. Decreasing cytomegalovirus transmission prenatally and in infancy might further decrease HIV transmission and lead to better health among HIV-exposed infants.

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Section: Resultsmentioning

confidence: 99%

“…The study reported a congenital CMV infection rate of 2.9% (22 infants); no association of congenital CMV infection was observed with length or type of maternal antiretroviral prophylaxis. However, low maternal CD4 + T-cell count (<200 cells/μL) during pregnancy was associated with congenital CMV (adjusted OR, 2.9; 95% CI, 1.2–7.3) [25]. …”

Section: Resultsmentioning

confidence: 99%

Cytomegalovirus Infection in Human Immunodeficiency Virus (HIV)–Exposed and HIV-Infected Infants: A Systematic Review

2015

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“…Case and control mothers proved to be well matched on these characteristics, as determined by a 2-sided Fisher's exact test (Supplementary Table 1). Other variables that may independently influence the risk of cCMV transmission within this population of HIV-infected mothers, including plasma HIV RNA load and peripheral CD4 + T-cell count [17][18][19] Table 1). Maternal plasma CMV load was not controlled for in our study, as all of the CMV-transmitting women had undetectable CMV viremia by qPCR.…”

Section: Characteristics Of the Study Population And Selection Of Casmentioning

confidence: 99%

“…While the risk of cCMV transmission among HIV-infected women varies depending on the severity of HIV-induced immunosuppression, rates of transmission in studies conducted prior to widespread availability of antiretroviral therapy (ART) have been reported to be as high as 11% [13][14][15]. Importantly, maternal ART has been an extremely effective strategy for the reduction of in utero HIV transmission, yet the burden of cCMV infection in HIVexposed infants remains high in ART-recipient maternal populations (1.5%-3.5% transmission rate) [16][17][18][19][20][21]. Furthermore, HIV-exposed infants, regardless of their HIV transmission status, more frequently sustain symptomatic cCMV infection, compared with congenitally infected, HIV-unexposed infants [22].…”

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confidence: 99%

Maternal Antibody Responses and Nonprimary Congenital Cytomegalovirus Infection of HIV-1–Exposed Infants

et al. 2016

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Risk of congenital cytomegalovirus (cCMV) transmission is highly dependent on the presence of preexisting maternal immunity, with the lowest rates observed in CMV-seroimmune populations. Among infants of CMV-seroimmune women, those who are exposed to human immunodeficiency virus (HIV) have an increased risk of acquiring cCMV infection as compared to HIV-unexposed infants. To better understand the risk factors of nonprimary cCMV transmission in HIV-infected women, we performed a casecontrol study in which CMV-specific plasma antibody responses from 19 CMV-transmitting and 57 CMV-nontransmitting women with chronic CMV/HIV coinfection were evaluated for the ability to predict the risk of cCMV infection. Primary multivariable conditional logistic regression analysis revealed an association between epithelial-tropic CMV neutralizing titers and a reduced risk of cCMV transmission (odds ratio [OR], 0.18; 95% confidence interval [CI], .03-.93; P = .04), although this effect was not significant following correction for multiple comparisons (false-discovery rate, 0.12). Exploratory analysis of the CMV specificity of plasma antibodies revealed that immunoglobulin G (IgG) responses against the glycoprotein B (gB) neutralizing epitope AD-2 had a borderline association with low risk of transmission (OR, 0.72; 95% CI, .51-1.00; P = .05), although this was not confirmed in a post hoc plasma anti-AD-2 IgG blocking assay. Our data suggest that maternal neutralizing antibody responses may play a role in protection against cCMV in HIV/CMV-coinfected populations.

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“…CMV infection in HIV-exposed infants was associated with decreased head circumference and delayed psychomotor development at 2 years of age [87]. Although cART during pregnancy decreases the risk of congenital and early postnatal CMV infection [88], higher incidence of congenital CMV is still reported in these infants and associated with microcephaly at birth [89,90]. Recently, a study from India described increased incidence of gastrointestinal infections in HIV-exposed infants compared with infants born to healthy women [84].…”

Section: Long-term Effects Of Fetal Exposure To Hiv On Infant Healthmentioning

confidence: 99%

Maternal HIV infection alters the immune balance in the mother and fetus; implications for pregnancy outcome and infant health

Pfeifer

Bunders

2016

Current Opinion in HIV and AIDS

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Birth Prevalence of Congenital Cytomegalovirus Among Infants of HIV-Infected Women on Prenatal Antiretroviral Prophylaxis in South Africa

Abstract: The birth prevalence of congenital CMV was high despite prenatal ARV prophylaxis, and was associated with advanced maternal immunosuppression.

Cited by 55 publications

References 17 publications

Cytomegalovirus Infection in Human Immunodeficiency Virus (HIV)–Exposed and HIV-Infected Infants: A Systematic Review

Cytomegalovirus Infection in Human Immunodeficiency Virus (HIV)–Exposed and HIV-Infected Infants: A Systematic Review

Maternal Antibody Responses and Nonprimary Congenital Cytomegalovirus Infection of HIV-1–Exposed Infants

Maternal HIV infection alters the immune balance in the mother and fetus; implications for pregnancy outcome and infant health

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