The Interrelated Transmission of HIV-1 and Cytomegalovirus During Gestation and Delivery in the Offspring of HIV-Infected Mothers

Khamduang, Woottichai; Jourdain, Gonzague; Sirirungsi, Wasna; Layangool, Prapaisri; Kanjanavanit, Suparat; Krittigamas, Pornsuda; Pagdi, Karin; Somsamai, Rosalin; Sirinontakan, Surat; Hinjiranandana, Temsiri; Ardonk, Wanna; Hongsiriwon, Suchat; Nanta, Sirisak; Borkird, Thitiporn; Lallemant, Marc; McIntosh, Kenneth; Ngo‐Giang‐Huong, Nicole

doi:10.1097/qai.0b013e31822d0433

Cited by 29 publications

(31 citation statements)

References 20 publications

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“…There was a significantly higher prevalence of congenital CMV infection among HIV-infected neonates, compared with HIV-uninfected neonates (Table 1). Similar results were seen in a smaller study of 51 HIV-exposed infants in Kenya [29], as well as in a retrospective case-control analysis of HIV-exposed infants enrolled in a clinical trial comparing long and short durations of maternal and infant use of zidovudine for the prevention of MTCT of HIV in Thailand [28]. Most recently, a subanalysis of data from a study in Malawi revealed that congenital CMV infection was more common among infants with in utero HIV infection, compared with HIV-exposed-uninfected infants (Table 1) [30].…”

Section: Resultssupporting

confidence: 82%

“…Ten of these addressed congenital CMV infection [12, 18, 21–24, 26, 28–30]. One early study in the United States examined data from 154 infants born during 1988–1995 [21].…”

Section: Resultsmentioning

confidence: 99%

“…Of the 6 studies assessing postnatal CMV infection, most found a significantly higher rate of CMV infection in HIV-infected children (Table 1) [12, 18, 22, 26–28]. The study by Chandwani et al was the only one that found no significant difference in postnatal CMV rates by HIV status; however, the P value for the comparison was marginally significant (Table 1), and the cumulative infection rate, including congenital CMV infection, was significantly higher in HIV-infected children, compared with HIV-exposed-uninfected children (30% vs 17%; P = .010) [26].…”

Section: Resultsmentioning

confidence: 99%

“…Two studies met the eligibility criteria for this question; one addressed sequence of perinatal infection events, while the other examined postnatal infection [28, 30]. …”

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: Resultssupporting

confidence: 82%

“…Ten of these addressed congenital CMV infection [12, 18, 21–24, 26, 28–30]. One early study in the United States examined data from 154 infants born during 1988–1995 [21].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Two studies met the eligibility criteria for this question; one addressed sequence of perinatal infection events, while the other examined postnatal infection [28, 30]. …”

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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“…Kovacs et al [16] had previously suggested that the increase in the coinfection rate could be caused by higher levels of cervical CMV shedding in HIV-infected women who also transmitted HIV to their infants at birth, as positive cervical CMV cultures had also been shown to correlate with perinatal CMV infection [32]. Also, because of impaired immunological surveillance, HIVinfected infants are unable to abort incipient CMV infections and are thus more susceptible to horizontal postnatal CMV acquisition [16,33]. However, maternal advanced HIV disease (i.e., CD4 counts ≤ 200 cells/mm 3 , viral load > 100,000 copies/mL), which could also explain a higher mother-to-child transmission of HIV and a higher shedding of more CMV in the saliva, cervix tissue, or urine, was not found to be significantly associated with CMV infection in the young infants in this study.…”

Section: Discussionmentioning

confidence: 99%

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

Anígilájé

Dabit

Nweke

et al. 2015

J Infect Dev Ctries

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Introduction: Cytomegalovirus (CMV) co-infection increases morbidity and mortality in human immunodeficiency virus (HIV) disease. There has been no study on CMV infection and its risk factors among Nigerian HIV-infected and/or HIV-exposed uninfected infants. Methodology: This was a cross-sectional cohort study at the Federal Medical Center, Makurdi, between January 2012 and March 2013. Acute CMV infection among consecutive three-month-old HIV-infected and HIV-exposed uninfected infants was determined using the enzyme-linked immunosorbent assay of the CMV immunoglobulin M (IgM). The relationship between acute CMV infections in the infants and the potential risk factors was tested using logistic regression analyses. Results: The prevalence of acute CMV infection was 41.4% (91/220), including 12.1% (11/91) and 87.9% (80/91) among the HIV-infected and the HIV-exposed uninfected infants, respectively. In multivariate logistic regression analyses, oropharyngeal candidiasis in the infants, HIV co-infection in the infants, maternal mastitis during breastfeeding, and the absence of maternal chronic CMV infections significantly increased the risk of acute CMV in the young infants. Conclusions: In our setting, concerted efforts to prevent and/or promptly treat oropharyngeal candidiasis and mastitis during breastfeeding may reduce the burden of CMV among HIV-infected and HIV-exposed uninfected infants. Public enlightenment on the mode of CMV transmission and its prevention is also important.

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

Gantt

Leister

et al. 2015

Journal of Medical Virology

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Background Congenital cytomegalovirus (cCMV) infection is common among infants born to HIV-infected women. Nelfinavir (NFV), an antiretroviral drug that is safe during pregnancy, inhibits CMV replication in vitro at concentrations that standard doses achieve in plasma. We hypothesized that infants born to women receiving NFV for prevention of mother-to-child transmission of HIV (PMTCT) would have a reduced prevalence of cCMV infection. Methods The prevalence of cCMV infection was compared among HIV-uninfected infants whose HIV-infected mothers either received NFV for ≥4 weeks during pregnancy (NFV-exposed) or did not receive any NFV in pregnancy (NFV-unexposed). CMV PCR was performed on infant blood samples collected at <3 weeks from birth. Results Of the 1,255 women included, 314 received NFV for ≥4 weeks during pregnancy and 941 did not receive any NFV during pregnancy. The overall prevalence of cCMV infection in the infants was 2.2%, which did not differ by maternal NFV use. Maternal CD4 T cell counts were inversely correlated with risk of cCMV infection, independent of the time NFV was initiated during gestation. Infants with cCMV infection were born 0.7 weeks earlier (p=0.010) and weighed 170 grams less (p=0.009) than uninfected infants. Conclusion Among HIV-exposed uninfected infants, cCMV infection was associated with adverse perinatal outcomes. NFV use in pregnancy was not associated with protection against cCMV. Safe and effective strategies to prevent cCMV infection are needed.

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The Interrelated Transmission of HIV-1 and Cytomegalovirus During Gestation and Delivery in the Offspring of HIV-Infected Mothers

Cited by 29 publications

References 20 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

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

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

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