Postnatal Cytomegalovirus Exposure in Infants of Antiretroviral-Treated and Untreated HIV-Infected Mothers

Abstract

HIV-1 and CMV are important pathogens transmitted via breastfeeding. Furthermore, perinatal CMV transmission may impact growth and disease progression in HIV-exposed infants. Although maternal antiretroviral therapy reduces milk HIV-1 RNA load and postnatal transmission, its impact on milk CMV load is unclear. We examined the relationship between milk CMV and HIV-1 load (4–6 weeks postpartum) and the impact of antiretroviral treatment in 69 HIV-infected, lactating Malawian women and assessed the relationship between milk CMV load and postnatal growth in HIV-exposed, breastfed infants through six months of age. Despite an association between milk HIV-1 RNA and CMV DNA load (0.39 log10 rise CMV load per log10 rise HIV-1 RNA load, 95% CI 0.13–0.66), milk CMV load was similar in antiretroviral-treated and untreated women. Higher milk CMV load was associated with lower length-for-age (−0.53, 95% CI: −0.96, −0.10) and weight-for-age (−0.40, 95% CI: −0.67, −0.13) Z-score at six months in exposed, uninfected infants. As the impact of maternal antiretroviral therapy on the magnitude of postnatal CMV exposure may be limited, our findings of an inverse relationship between infant growth and milk CMV load highlight the importance of defining the role of perinatal CMV exposure on growth faltering of HIV-exposed infants.

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

“…This postnatal CMV transmission may have occurred despite the fact that all the mothers of the subjects in our cohort were on HAART during pregnancy and throughout the breastfeeding period. This also tends to support the study of Meyer et al [37] in Malawi, whereby only minimal impact of HAART on breast milk CMV load was seen, suggesting that expanded maternal use of antiretroviral therapy may not reduce the risk of infant postnatal CMV acquisition via breast milk [37]. In the cohort of Gantt et al's study [38], mastitis was not seen in CMV-Epstein Barr virus co-infection, even though both viruses could cause or be reactivated by inflammation.…”

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

“…Most of the evidence on the frequency of congenital CMV infection among HIV-exposed infants accumulated prior to the combination ART (cART) era [20–22]. However, 5 recent studies shed some light on this question and met the criteria to be included in this review [12, 20, 23–25].…”

“…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].…”

“…The effect of cART on breast milk CMV load was examined among 69 HIV-infected, lactating Malawian women [20]. There was an association between milk HIV-1 RNA and CMV DNA load.…”

“…However, milk CMV load was similar in women who did and those who did not receive ART in this small sample, leading the authors to postulate that the impact of maternal ART on the magnitude of infant CMV exposure may be limited. Of interest, there was an inverse relationship between milk CMV load and infant growth [20]. …”