TY - JOUR
T1 - Cytomegalovirus Urinary Shedding in HIV-infected Pregnant Women and Congenital Cytomegalovirus Infection
AU - NICHD HPTN 040 Study Team
AU - Adachi, Kristina
AU - Xu, Jiahong
AU - Ank, Bonnie
AU - Watts, D. Heather
AU - Mofenson, Lynne M.
AU - Pilotto, Jose Henrique
AU - Joao, Esau
AU - Santos, Breno
AU - Fonseca, Rosana
AU - Kreitchmann, Regis
AU - Pinto, Jorge
AU - Mussi-Pinhata, Marisa M.
AU - Gray, Glenda
AU - Theron, Gerhard
AU - Morgado, Mariza G.
AU - Bryson, Yvonne J.
AU - Veloso, Valdilea G.
AU - Klausner, Jeffrey D.
AU - Moye, Jack
AU - Nielsen-Saines, Karin
AU - Ceriotto, Mariana
AU - Szyld, Edgardo
AU - Marzo, Silvia
AU - Ferreira, Flavia Faleiro
AU - Kakehasi, Fabiana
AU - Lira, Rita
AU - De Fraga, Carla Franceschini
AU - Coelho, Debora Fernandes
AU - Sanseverino, Alberto
AU - Ribeiro, Luis Carlos
AU - Cruz, M. Leticia Santos
AU - Martins, Ezequias
AU - De Menezes, Jacqueline Anita
AU - Salgado, Luisa Andrea Torres
AU - Cordovil, Ana Valeria
AU - Gouveia, Andréa
AU - Mazzucanti, Priscila
AU - Ribeiro, Jorge Eurico
AU - Duarte, Geraldo
AU - Barbaro, Adriana Aparecida Tiraboschi
AU - Vieira, Carolina Sales
AU - Machado, Daisy Maria
AU - Succi, Regina
AU - Cotton, Mark
AU - Louw, Jeanne
AU - Agwu, Allison
AU - Anderson, Jean
AU - Ellen, Jonathan
AU - Hutton, Nancy
AU - Siberry, George
N1 - Publisher Copyright:
© The Author 2017.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Background. Cytomegalovirus (CMV) urinary shedding in pregnant women infected with human immunodeficiency virus (HIV) was evaluated to determine whether it poses an increased risk for congenital CMV infection (cCMV). Methods. A subset of mother-infant pairs enrolled in the perinatal NICHD HPTN 040 study (distinguished by no antiretroviral use before labor) was evaluated. Maternal and infant urines were tested by qualitative real-time polymerase chain reaction (RT-PCR) for CMV DNA with quantitative RT-PCR performed on positive specimens. Results. Urine specimens were available for 260 women with 85.4% from the Americas and 14.6% from South Africa. Twenty-four women (9.2%) had detectable CMV viruria by qualitative PCR. Maternal CMV viruria was not associated with mean CD4 cell counts or HIV viral load but was associated with younger maternal age (P =.02). Overall, 10 of 260 infants (3.8%) had cCMV. Women with detectable peripartum CMV viruria were more likely to have infants with cCMV than those without: 20.8% (5/24) versus 2.1% (5/236), (P =.0001). Women with CMV viruria had significantly higher rates of HIV perinatal transmission (29.2% vs. 8.1%, P =.002). They were 5 times (adjusted odds ratio [aOR] = 5.6, 95% confidence interval [CI] 1.9-16.8) and nearly 30 times (aOR, 29.7; 95% CI, 5.4-164.2) more likely to transmit HIV and CMV to their infants, respectively. Maternal gonorrhea (aOR, 19.5; 95% CI, 2.5-151.3) and higher maternal HIV log10 viral load (OR, 2.8; 95% CI, 1.3-6.3) were also significant risk factors for cCMV. Conclusion. In this cohort of HIV-infected pregnant women not on antiretrovirals, urinary CMV shedding was a significant risk factor for CMV and HIV transmission to infants.
AB - Background. Cytomegalovirus (CMV) urinary shedding in pregnant women infected with human immunodeficiency virus (HIV) was evaluated to determine whether it poses an increased risk for congenital CMV infection (cCMV). Methods. A subset of mother-infant pairs enrolled in the perinatal NICHD HPTN 040 study (distinguished by no antiretroviral use before labor) was evaluated. Maternal and infant urines were tested by qualitative real-time polymerase chain reaction (RT-PCR) for CMV DNA with quantitative RT-PCR performed on positive specimens. Results. Urine specimens were available for 260 women with 85.4% from the Americas and 14.6% from South Africa. Twenty-four women (9.2%) had detectable CMV viruria by qualitative PCR. Maternal CMV viruria was not associated with mean CD4 cell counts or HIV viral load but was associated with younger maternal age (P =.02). Overall, 10 of 260 infants (3.8%) had cCMV. Women with detectable peripartum CMV viruria were more likely to have infants with cCMV than those without: 20.8% (5/24) versus 2.1% (5/236), (P =.0001). Women with CMV viruria had significantly higher rates of HIV perinatal transmission (29.2% vs. 8.1%, P =.002). They were 5 times (adjusted odds ratio [aOR] = 5.6, 95% confidence interval [CI] 1.9-16.8) and nearly 30 times (aOR, 29.7; 95% CI, 5.4-164.2) more likely to transmit HIV and CMV to their infants, respectively. Maternal gonorrhea (aOR, 19.5; 95% CI, 2.5-151.3) and higher maternal HIV log10 viral load (OR, 2.8; 95% CI, 1.3-6.3) were also significant risk factors for cCMV. Conclusion. In this cohort of HIV-infected pregnant women not on antiretrovirals, urinary CMV shedding was a significant risk factor for CMV and HIV transmission to infants.
KW - CMV viruria
KW - HIV
KW - HIV perinatal transmission
KW - congenital CMV
KW - pregnancy
UR - http://www.scopus.com/inward/record.url?scp=85027855552&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85027855552&partnerID=8YFLogxK
U2 - 10.1093/cid/cix222
DO - 10.1093/cid/cix222
M3 - Article
C2 - 28369278
AN - SCOPUS:85027855552
SN - 1058-4838
VL - 65
SP - 405
EP - 413
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 3
ER -