Incidence of CMV co-infection in HIV-positive women and their neonates in a tertiary referral centre: a cohort study

Abstract

Co-infection with CMV in HIV-positive pregnant women is associated with perinatal mother-to-child transmission (MTCT) of both viruses. This retrospective study reports on the incidence of maternal and neonatal CMV (presence of anti-CMV IgG and IgM, CMV DNA PCR and/or CMV virus isolation) in high-risk pregnancies due to maternal HIV infection, MTCT of HIV and/or CMV. One hundred and eleven maternal samples and 75 matched neonatal samples were available for HIV and subsequent CMV testing. In this cohort of HIV-positive pregnant women, 96 (86.5 %) serum samples were anti-CMV IgG positive. In nine (9.4 %) of these, anti-CMV IgM was detected, and in none of them a maternal primary CMV infection was suspected. Fifty-seven (51.8 %) maternal serum samples were tested retrospectively by CMV DNA PCR; one sample was positive (0.9 %). All matched neonates were tested for HIV by PCR in the first month of life; HIV transmission was detected in one case. In 74 (67.2 %) of neonates, CMV testing was performed. Sixty-six of these serum samples were tested retrospectively by CMV DNA PCR. Two newborns (2.7 %) showed laboratory markers for CMV infection (one by detection of CMV DNA in plasma, and one by isolation of CMV from a urine sample). In the follow-up, neither of these two showed clinical signs for active CMV disease. We discussed these findings in the light of the national official guidelines. All CMV transmissions occurred due to maternal reinfection or endogenous reactivation. This suggests the success of highly active antiretroviral therapy in preventing MTCT of HIV and CMV disease and highlights the importance of adequate care and follow-up.

Risk of congenital cytomegalovirus infection among HIV‐exposed uninfected infants is not decreased by maternal nelfinavir use during pregnancy

“…Risk factors for cCMV infection in HIV‐exposed uninfected children have been previously described. Maternal CMV serostatus was not available from these cohorts; however, most HIV‐1‐infected pregnant women are co‐infected with CMV even in resource‐rich countries [Reitter et al, ], and maternal serostatus is a poor predictor of the risk of congenital CMV transmission [Britt, ]. Our findings are consistent with reports that type of maternal antiretroviral therapy is not associated with the rate of cCMV infection [Guibert et al, ; Frederick et al, ], whereas maternal CD4 T cell count <200 cells/mm 3 is independently associated with cCMV infection [Guibert et al, ].…”

Congenital Cytomegalovirus and HIV Perinatal Transmission

“…Apart from two exceptions in smaller studies, 19, 25 the cCMV rates among HIV-exposed, uninfected infants in our sub-study were higher than those seen in the majority of other published studies ranging from 2.2% to 4.6% among studies of HIV-exposed infants in the U.S., France, South Africa, Brazil, and Thailand. 11, 13–16, 26–30 Among HIV-infected infants, cCMV rates correlated with those reported in other studies, which typically ranged from 4.3% to 21%; 11, 12, 14, 16, 29 but included some studies with rates as low as 0% 13 and others with rates as high as 26–29%. 31, 32…”

Cytomegalovirus infection in HIV-infected versus non-infected infants and HIV disease progression in Cytomegalovirus infected versus non infected infants early treated with cART in the ANRS 12140—Pediacam study in Cameroon

“…Similarly, Manicklal and colleagues did not find any relationship between ARV prophylaxis and congenital CMV infection in HIV-infected infants [11]. However other studies have suggested that there is an effect of ARV prophylaxis on CMV infection [7, 22, 23], cART reduces serological biomarkers of inflammation and immune activation [24, 25]. ARV could impede CMV reactivation in HIV-infected pregnant women and thereby reduce the possibility of CMV transmission to infants born to mothers who took prophylactic regimens.…”