Effect of cytomegalovirus infection on breastfeeding transmission of HIV and on the health of infants born to HIV-infected mothers

Tiffany S. Chang, Jeffrey Wiener, Sheila C. Dollard, Minal M. Amin, Sascha Ellington, Charles Chasela, Dumbani Kayira, Gerald Tegha, Deborah Kamwendo, Denise J. Jamieson, Charlie Van Der Horst, Athena P. Kourtis, Linda Adair, Yusuf Ahmed, Mounir Ait-Khaled, Sandra Albrecht, Shrikant Bangdiwala, Ronald Bayer, Margaret Bentley, Brian BramsonEmily Bobrow, Nicola Boyle, Sal Butera, Charity Chavula, Joseph Chimerang'ambe, Maggie Chigwenembe, Maria Chikasema, Norah Chikhungu, David Chilongozi, Grace Chiudzu, Lenesi Chome, Anne Cole, Amanda Corbett, Amy Corneli, Anna Dow, Ann Duerr, Henry Eliya, Joseph Eron, Sherry Farr, Yvonne Owens Ferguson, Susan Fiscus, Valerie Flax, Ali Fokar, Shannon Galvin, Laura Guay, Chad Heilig, Irving Hoffman, Elizabeth Hooten, Mina Hosseinipour, Michael Hudgens, Stacy Hurst, Lisa Hyde, George Joaki, David Jones, Elizabeth Jordan-Bell, Zebrone Kacheche, Esmie Kamanga, Gift Kamanga, Coxcilly Kampani, Portia Kamthunzi, Cecilia Kanyama, Angela Kashuba, Damson Kathyola, Peter Kazembe, Caroline C. King, Rodney Knight, Robert Krysiak, Jacob Kumwenda, Hana Lee, Edde Loeliger, Dustin Long, Misheck Luhanga, Victor Madhlopa, Maganizo Majawa, Alice Maida, Cheryl Marcus, Francis Martinson, Navdeep Thoofer, Chrissie Matiki, Douglas Mayers, Isabel Mayuni, Marita McDonough, Joyce Meme, Ceppie Merry, Khama Mita, Chimwemwe Mkomawanthu, Gertrude Mndala, Ibrahim Mndala, Agnes Moses, Albans Msika, Wezi Msungama, Beatrice Mtimuni, Jane Muita, Noel Mumba, Bonface Musis, Charles Mwansambo, Gerald Mwapasa, Jacqueline Nkhoma, Megan Parker, Richard Pendame, Ellen Piwoz, Byron Raines, Zane Ramdas, John Rublein, Mairin Ryan, Ian Sanne, Christopher Sellers, Diane Shugars, Dorothy Sichali, Wendy Snowden, Alice Soko, Allison Spensley, Jean Marc Steens, Martin Tembo, Roshan Thomas, Hsiao Chuan Tien, Beth Tohill, Charles Van Der Horst, Esther Waalberg, Elizabeth Widen, Cathy Wilfert, Patricia Wiyo, Innocent Zgambo, Chifundo Zimba

Research output: Contribution to journalArticle

Abstract

Background: Cytomegalovirus (CMV) infection can be acquired in utero or postnatally through horizontal transmission and breastfeeding. The effect of postnatal CMV infection on postnatal HIV transmission is unknown. Methods: The Breastfeeding, Antiretrovirals and Nutrition study, conducted in Malawi, randomized 2369 mothers and their infants to three antiretroviral prophylaxis arms - mother (triple regimen), infant (nevirapine), or neither - for 28 weeks of breastfeeding, followed by weaning. Stored plasma and peripheral blood mononuclear cell specimens were available for 492 infants at 24 weeks and were tested with CMV PCR. Available samples from infants who were CMV PCR-positive at 24 weeks were also tested at birth (N = 242), and from infants PCR-negative at 24 weeks were tested at 48 weeks (N = 96). Cox proportional-hazards models were used to determine if CMV infection was associated with infant morbidity, mortality, or postnatal HIV acquisition. Results: At 24 weeks of age, CMV DNA was detected in 345/492 infants (70.1%); the estimated congenital CMV infection rate was 2.3%, and the estimated rate of CMV infection at 48 weeks was 78.5%. CMV infection at 24 weeks was associated with subsequent HIV acquisition through breastfeeding or infant death between 24 and 48 weeks of age (hazard ratio 4.27, P = 0.05). Conclusion: Most breastfed infants of HIV-infected mothers in this resource-limited setting are infected with CMV by 24 weeks of age. Early CMV infection may be a risk factor for subsequent infant HIV infection through breastfeeding, pointing to the need for comprehensive approaches in order to achieve elimination of breastfeeding transmission of HIV.

Original languageEnglish (US)
Pages (from-to)831-836
Number of pages6
JournalAIDS
Volume29
Issue number7
DOIs
StatePublished - Apr 24 2015
Externally publishedYes

Fingerprint

Cytomegalovirus Infections
Breast Feeding
Mothers
HIV
Cytomegalovirus
Polymerase Chain Reaction
Nevirapine
Malawi
Infant Health
Infant Mortality
Weaning
Proportional Hazards Models
HIV Infections
Blood Cells
Parturition
Morbidity
DNA

Keywords

  • breastfeeding
  • cytomegalovirus
  • HIV
  • infant
  • mother-to-child transmission

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Chang, T. S., Wiener, J., Dollard, S. C., Amin, M. M., Ellington, S., Chasela, C., ... Zimba, C. (2015). Effect of cytomegalovirus infection on breastfeeding transmission of HIV and on the health of infants born to HIV-infected mothers. AIDS, 29(7), 831-836. https://doi.org/10.1097/QAD.0000000000000617

Effect of cytomegalovirus infection on breastfeeding transmission of HIV and on the health of infants born to HIV-infected mothers. / Chang, Tiffany S.; Wiener, Jeffrey; Dollard, Sheila C.; Amin, Minal M.; Ellington, Sascha; Chasela, Charles; Kayira, Dumbani; Tegha, Gerald; Kamwendo, Deborah; Jamieson, Denise J.; Van Der Horst, Charlie; Kourtis, Athena P.; Adair, Linda; Ahmed, Yusuf; Ait-Khaled, Mounir; Albrecht, Sandra; Bangdiwala, Shrikant; Bayer, Ronald; Bentley, Margaret; Bramson, Brian; Bobrow, Emily; Boyle, Nicola; Butera, Sal; Chavula, Charity; Chimerang'ambe, Joseph; Chigwenembe, Maggie; Chikasema, Maria; Chikhungu, Norah; Chilongozi, David; Chiudzu, Grace; Chome, Lenesi; Cole, Anne; Corbett, Amanda; Corneli, Amy; Dow, Anna; Duerr, Ann; Eliya, Henry; Eron, Joseph; Farr, Sherry; Ferguson, Yvonne Owens; Fiscus, Susan; Flax, Valerie; Fokar, Ali; Galvin, Shannon; Guay, Laura; Heilig, Chad; Hoffman, Irving; Hooten, Elizabeth; Hosseinipour, Mina; Hudgens, Michael; Hurst, Stacy; Hyde, Lisa; Joaki, George; Jones, David; Jordan-Bell, Elizabeth; Kacheche, Zebrone; Kamanga, Esmie; Kamanga, Gift; Kampani, Coxcilly; Kamthunzi, Portia; Kanyama, Cecilia; Kashuba, Angela; Kathyola, Damson; Kazembe, Peter; King, Caroline C.; Knight, Rodney; Krysiak, Robert; Kumwenda, Jacob; Lee, Hana; Loeliger, Edde; Long, Dustin; Luhanga, Misheck; Madhlopa, Victor; Majawa, Maganizo; Maida, Alice; Marcus, Cheryl; Martinson, Francis; Thoofer, Navdeep; Matiki, Chrissie; Mayers, Douglas; Mayuni, Isabel; McDonough, Marita; Meme, Joyce; Merry, Ceppie; Mita, Khama; Mkomawanthu, Chimwemwe; Mndala, Gertrude; Mndala, Ibrahim; Moses, Agnes; Msika, Albans; Msungama, Wezi; Mtimuni, Beatrice; Muita, Jane; Mumba, Noel; Musis, Bonface; Mwansambo, Charles; Mwapasa, Gerald; Nkhoma, Jacqueline; Parker, Megan; Pendame, Richard; Piwoz, Ellen; Raines, Byron; Ramdas, Zane; Rublein, John; Ryan, Mairin; Sanne, Ian; Sellers, Christopher; Shugars, Diane; Sichali, Dorothy; Snowden, Wendy; Soko, Alice; Spensley, Allison; Steens, Jean Marc; Tembo, Martin; Thomas, Roshan; Tien, Hsiao Chuan; Tohill, Beth; Van Der Horst, Charles; Waalberg, Esther; Widen, Elizabeth; Wilfert, Cathy; Wiyo, Patricia; Zgambo, Innocent; Zimba, Chifundo.

In: AIDS, Vol. 29, No. 7, 24.04.2015, p. 831-836.

Research output: Contribution to journalArticle

Chang, TS, Wiener, J, Dollard, SC, Amin, MM, Ellington, S, Chasela, C, Kayira, D, Tegha, G, Kamwendo, D, Jamieson, DJ, Van Der Horst, C, Kourtis, AP, Adair, L, Ahmed, Y, Ait-Khaled, M, Albrecht, S, Bangdiwala, S, Bayer, R, Bentley, M, Bramson, B, Bobrow, E, Boyle, N, Butera, S, Chavula, C, Chimerang'ambe, J, Chigwenembe, M, Chikasema, M, Chikhungu, N, Chilongozi, D, Chiudzu, G, Chome, L, Cole, A, Corbett, A, Corneli, A, Dow, A, Duerr, A, Eliya, H, Eron, J, Farr, S, Ferguson, YO, Fiscus, S, Flax, V, Fokar, A, Galvin, S, Guay, L, Heilig, C, Hoffman, I, Hooten, E, Hosseinipour, M, Hudgens, M, Hurst, S, Hyde, L, Joaki, G, Jones, D, Jordan-Bell, E, Kacheche, Z, Kamanga, E, Kamanga, G, Kampani, C, Kamthunzi, P, Kanyama, C, Kashuba, A, Kathyola, D, Kazembe, P, King, CC, Knight, R, Krysiak, R, Kumwenda, J, Lee, H, Loeliger, E, Long, D, Luhanga, M, Madhlopa, V, Majawa, M, Maida, A, Marcus, C, Martinson, F, Thoofer, N, Matiki, C, Mayers, D, Mayuni, I, McDonough, M, Meme, J, Merry, C, Mita, K, Mkomawanthu, C, Mndala, G, Mndala, I, Moses, A, Msika, A, Msungama, W, Mtimuni, B, Muita, J, Mumba, N, Musis, B, Mwansambo, C, Mwapasa, G, Nkhoma, J, Parker, M, Pendame, R, Piwoz, E, Raines, B, Ramdas, Z, Rublein, J, Ryan, M, Sanne, I, Sellers, C, Shugars, D, Sichali, D, Snowden, W, Soko, A, Spensley, A, Steens, JM, Tembo, M, Thomas, R, Tien, HC, Tohill, B, Van Der Horst, C, Waalberg, E, Widen, E, Wilfert, C, Wiyo, P, Zgambo, I & Zimba, C 2015, 'Effect of cytomegalovirus infection on breastfeeding transmission of HIV and on the health of infants born to HIV-infected mothers', AIDS, vol. 29, no. 7, pp. 831-836. https://doi.org/10.1097/QAD.0000000000000617
Chang, Tiffany S. ; Wiener, Jeffrey ; Dollard, Sheila C. ; Amin, Minal M. ; Ellington, Sascha ; Chasela, Charles ; Kayira, Dumbani ; Tegha, Gerald ; Kamwendo, Deborah ; Jamieson, Denise J. ; Van Der Horst, Charlie ; Kourtis, Athena P. ; Adair, Linda ; Ahmed, Yusuf ; Ait-Khaled, Mounir ; Albrecht, Sandra ; Bangdiwala, Shrikant ; Bayer, Ronald ; Bentley, Margaret ; Bramson, Brian ; Bobrow, Emily ; Boyle, Nicola ; Butera, Sal ; Chavula, Charity ; Chimerang'ambe, Joseph ; Chigwenembe, Maggie ; Chikasema, Maria ; Chikhungu, Norah ; Chilongozi, David ; Chiudzu, Grace ; Chome, Lenesi ; Cole, Anne ; Corbett, Amanda ; Corneli, Amy ; Dow, Anna ; Duerr, Ann ; Eliya, Henry ; Eron, Joseph ; Farr, Sherry ; Ferguson, Yvonne Owens ; Fiscus, Susan ; Flax, Valerie ; Fokar, Ali ; Galvin, Shannon ; Guay, Laura ; Heilig, Chad ; Hoffman, Irving ; Hooten, Elizabeth ; Hosseinipour, Mina ; Hudgens, Michael ; Hurst, Stacy ; Hyde, Lisa ; Joaki, George ; Jones, David ; Jordan-Bell, Elizabeth ; Kacheche, Zebrone ; Kamanga, Esmie ; Kamanga, Gift ; Kampani, Coxcilly ; Kamthunzi, Portia ; Kanyama, Cecilia ; Kashuba, Angela ; Kathyola, Damson ; Kazembe, Peter ; King, Caroline C. ; Knight, Rodney ; Krysiak, Robert ; Kumwenda, Jacob ; Lee, Hana ; Loeliger, Edde ; Long, Dustin ; Luhanga, Misheck ; Madhlopa, Victor ; Majawa, Maganizo ; Maida, Alice ; Marcus, Cheryl ; Martinson, Francis ; Thoofer, Navdeep ; Matiki, Chrissie ; Mayers, Douglas ; Mayuni, Isabel ; McDonough, Marita ; Meme, Joyce ; Merry, Ceppie ; Mita, Khama ; Mkomawanthu, Chimwemwe ; Mndala, Gertrude ; Mndala, Ibrahim ; Moses, Agnes ; Msika, Albans ; Msungama, Wezi ; Mtimuni, Beatrice ; Muita, Jane ; Mumba, Noel ; Musis, Bonface ; Mwansambo, Charles ; Mwapasa, Gerald ; Nkhoma, Jacqueline ; Parker, Megan ; Pendame, Richard ; Piwoz, Ellen ; Raines, Byron ; Ramdas, Zane ; Rublein, John ; Ryan, Mairin ; Sanne, Ian ; Sellers, Christopher ; Shugars, Diane ; Sichali, Dorothy ; Snowden, Wendy ; Soko, Alice ; Spensley, Allison ; Steens, Jean Marc ; Tembo, Martin ; Thomas, Roshan ; Tien, Hsiao Chuan ; Tohill, Beth ; Van Der Horst, Charles ; Waalberg, Esther ; Widen, Elizabeth ; Wilfert, Cathy ; Wiyo, Patricia ; Zgambo, Innocent ; Zimba, Chifundo. / Effect of cytomegalovirus infection on breastfeeding transmission of HIV and on the health of infants born to HIV-infected mothers. In: AIDS. 2015 ; Vol. 29, No. 7. pp. 831-836.
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title = "Effect of cytomegalovirus infection on breastfeeding transmission of HIV and on the health of infants born to HIV-infected mothers",
abstract = "Background: Cytomegalovirus (CMV) infection can be acquired in utero or postnatally through horizontal transmission and breastfeeding. The effect of postnatal CMV infection on postnatal HIV transmission is unknown. Methods: The Breastfeeding, Antiretrovirals and Nutrition study, conducted in Malawi, randomized 2369 mothers and their infants to three antiretroviral prophylaxis arms - mother (triple regimen), infant (nevirapine), or neither - for 28 weeks of breastfeeding, followed by weaning. Stored plasma and peripheral blood mononuclear cell specimens were available for 492 infants at 24 weeks and were tested with CMV PCR. Available samples from infants who were CMV PCR-positive at 24 weeks were also tested at birth (N = 242), and from infants PCR-negative at 24 weeks were tested at 48 weeks (N = 96). Cox proportional-hazards models were used to determine if CMV infection was associated with infant morbidity, mortality, or postnatal HIV acquisition. Results: At 24 weeks of age, CMV DNA was detected in 345/492 infants (70.1{\%}); the estimated congenital CMV infection rate was 2.3{\%}, and the estimated rate of CMV infection at 48 weeks was 78.5{\%}. CMV infection at 24 weeks was associated with subsequent HIV acquisition through breastfeeding or infant death between 24 and 48 weeks of age (hazard ratio 4.27, P = 0.05). Conclusion: Most breastfed infants of HIV-infected mothers in this resource-limited setting are infected with CMV by 24 weeks of age. Early CMV infection may be a risk factor for subsequent infant HIV infection through breastfeeding, pointing to the need for comprehensive approaches in order to achieve elimination of breastfeeding transmission of HIV.",
keywords = "breastfeeding, cytomegalovirus, HIV, infant, mother-to-child transmission",
author = "Chang, {Tiffany S.} and Jeffrey Wiener and Dollard, {Sheila C.} and Amin, {Minal M.} and Sascha Ellington and Charles Chasela and Dumbani Kayira and Gerald Tegha and Deborah Kamwendo and Jamieson, {Denise J.} and {Van Der Horst}, Charlie and Kourtis, {Athena P.} and Linda Adair and Yusuf Ahmed and Mounir Ait-Khaled and Sandra Albrecht and Shrikant Bangdiwala and Ronald Bayer and Margaret Bentley and Brian Bramson and Emily Bobrow and Nicola Boyle and Sal Butera and Charity Chavula and Joseph Chimerang'ambe and Maggie Chigwenembe and Maria Chikasema and Norah Chikhungu and David Chilongozi and Grace Chiudzu and Lenesi Chome and Anne Cole and Amanda Corbett and Amy Corneli and Anna Dow and Ann Duerr and Henry Eliya and Joseph Eron and Sherry Farr and Ferguson, {Yvonne Owens} and Susan Fiscus and Valerie Flax and Ali Fokar and Shannon Galvin and Laura Guay and Chad Heilig and Irving Hoffman and Elizabeth Hooten and Mina Hosseinipour and Michael Hudgens and Stacy Hurst and Lisa Hyde and George Joaki and David Jones and Elizabeth Jordan-Bell and Zebrone Kacheche and Esmie Kamanga and Gift Kamanga and Coxcilly Kampani and Portia Kamthunzi and Cecilia Kanyama and Angela Kashuba and Damson Kathyola and Peter Kazembe and King, {Caroline C.} and Rodney Knight and Robert Krysiak and Jacob Kumwenda and Hana Lee and Edde Loeliger and Dustin Long and Misheck Luhanga and Victor Madhlopa and Maganizo Majawa and Alice Maida and Cheryl Marcus and Francis Martinson and Navdeep Thoofer and Chrissie Matiki and Douglas Mayers and Isabel Mayuni and Marita McDonough and Joyce Meme and Ceppie Merry and Khama Mita and Chimwemwe Mkomawanthu and Gertrude Mndala and Ibrahim Mndala and Agnes Moses and Albans Msika and Wezi Msungama and Beatrice Mtimuni and Jane Muita and Noel Mumba and Bonface Musis and Charles Mwansambo and Gerald Mwapasa and Jacqueline Nkhoma and Megan Parker and Richard Pendame and Ellen Piwoz and Byron Raines and Zane Ramdas and John Rublein and Mairin Ryan and Ian Sanne and Christopher Sellers and Diane Shugars and Dorothy Sichali and Wendy Snowden and Alice Soko and Allison Spensley and Steens, {Jean Marc} and Martin Tembo and Roshan Thomas and Tien, {Hsiao Chuan} and Beth Tohill and {Van Der Horst}, Charles and Esther Waalberg and Elizabeth Widen and Cathy Wilfert and Patricia Wiyo and Innocent Zgambo and Chifundo Zimba",
year = "2015",
month = "4",
day = "24",
doi = "10.1097/QAD.0000000000000617",
language = "English (US)",
volume = "29",
pages = "831--836",
journal = "AIDS",
issn = "0269-9370",
publisher = "Lippincott Williams and Wilkins",
number = "7",

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TY - JOUR

T1 - Effect of cytomegalovirus infection on breastfeeding transmission of HIV and on the health of infants born to HIV-infected mothers

AU - Chang, Tiffany S.

AU - Wiener, Jeffrey

AU - Dollard, Sheila C.

AU - Amin, Minal M.

AU - Ellington, Sascha

AU - Chasela, Charles

AU - Kayira, Dumbani

AU - Tegha, Gerald

AU - Kamwendo, Deborah

AU - Jamieson, Denise J.

AU - Van Der Horst, Charlie

AU - Kourtis, Athena P.

AU - Adair, Linda

AU - Ahmed, Yusuf

AU - Ait-Khaled, Mounir

AU - Albrecht, Sandra

AU - Bangdiwala, Shrikant

AU - Bayer, Ronald

AU - Bentley, Margaret

AU - Bramson, Brian

AU - Bobrow, Emily

AU - Boyle, Nicola

AU - Butera, Sal

AU - Chavula, Charity

AU - Chimerang'ambe, Joseph

AU - Chigwenembe, Maggie

AU - Chikasema, Maria

AU - Chikhungu, Norah

AU - Chilongozi, David

AU - Chiudzu, Grace

AU - Chome, Lenesi

AU - Cole, Anne

AU - Corbett, Amanda

AU - Corneli, Amy

AU - Dow, Anna

AU - Duerr, Ann

AU - Eliya, Henry

AU - Eron, Joseph

AU - Farr, Sherry

AU - Ferguson, Yvonne Owens

AU - Fiscus, Susan

AU - Flax, Valerie

AU - Fokar, Ali

AU - Galvin, Shannon

AU - Guay, Laura

AU - Heilig, Chad

AU - Hoffman, Irving

AU - Hooten, Elizabeth

AU - Hosseinipour, Mina

AU - Hudgens, Michael

AU - Hurst, Stacy

AU - Hyde, Lisa

AU - Joaki, George

AU - Jones, David

AU - Jordan-Bell, Elizabeth

AU - Kacheche, Zebrone

AU - Kamanga, Esmie

AU - Kamanga, Gift

AU - Kampani, Coxcilly

AU - Kamthunzi, Portia

AU - Kanyama, Cecilia

AU - Kashuba, Angela

AU - Kathyola, Damson

AU - Kazembe, Peter

AU - King, Caroline C.

AU - Knight, Rodney

AU - Krysiak, Robert

AU - Kumwenda, Jacob

AU - Lee, Hana

AU - Loeliger, Edde

AU - Long, Dustin

AU - Luhanga, Misheck

AU - Madhlopa, Victor

AU - Majawa, Maganizo

AU - Maida, Alice

AU - Marcus, Cheryl

AU - Martinson, Francis

AU - Thoofer, Navdeep

AU - Matiki, Chrissie

AU - Mayers, Douglas

AU - Mayuni, Isabel

AU - McDonough, Marita

AU - Meme, Joyce

AU - Merry, Ceppie

AU - Mita, Khama

AU - Mkomawanthu, Chimwemwe

AU - Mndala, Gertrude

AU - Mndala, Ibrahim

AU - Moses, Agnes

AU - Msika, Albans

AU - Msungama, Wezi

AU - Mtimuni, Beatrice

AU - Muita, Jane

AU - Mumba, Noel

AU - Musis, Bonface

AU - Mwansambo, Charles

AU - Mwapasa, Gerald

AU - Nkhoma, Jacqueline

AU - Parker, Megan

AU - Pendame, Richard

AU - Piwoz, Ellen

AU - Raines, Byron

AU - Ramdas, Zane

AU - Rublein, John

AU - Ryan, Mairin

AU - Sanne, Ian

AU - Sellers, Christopher

AU - Shugars, Diane

AU - Sichali, Dorothy

AU - Snowden, Wendy

AU - Soko, Alice

AU - Spensley, Allison

AU - Steens, Jean Marc

AU - Tembo, Martin

AU - Thomas, Roshan

AU - Tien, Hsiao Chuan

AU - Tohill, Beth

AU - Van Der Horst, Charles

AU - Waalberg, Esther

AU - Widen, Elizabeth

AU - Wilfert, Cathy

AU - Wiyo, Patricia

AU - Zgambo, Innocent

AU - Zimba, Chifundo

PY - 2015/4/24

Y1 - 2015/4/24

N2 - Background: Cytomegalovirus (CMV) infection can be acquired in utero or postnatally through horizontal transmission and breastfeeding. The effect of postnatal CMV infection on postnatal HIV transmission is unknown. Methods: The Breastfeeding, Antiretrovirals and Nutrition study, conducted in Malawi, randomized 2369 mothers and their infants to three antiretroviral prophylaxis arms - mother (triple regimen), infant (nevirapine), or neither - for 28 weeks of breastfeeding, followed by weaning. Stored plasma and peripheral blood mononuclear cell specimens were available for 492 infants at 24 weeks and were tested with CMV PCR. Available samples from infants who were CMV PCR-positive at 24 weeks were also tested at birth (N = 242), and from infants PCR-negative at 24 weeks were tested at 48 weeks (N = 96). Cox proportional-hazards models were used to determine if CMV infection was associated with infant morbidity, mortality, or postnatal HIV acquisition. Results: At 24 weeks of age, CMV DNA was detected in 345/492 infants (70.1%); the estimated congenital CMV infection rate was 2.3%, and the estimated rate of CMV infection at 48 weeks was 78.5%. CMV infection at 24 weeks was associated with subsequent HIV acquisition through breastfeeding or infant death between 24 and 48 weeks of age (hazard ratio 4.27, P = 0.05). Conclusion: Most breastfed infants of HIV-infected mothers in this resource-limited setting are infected with CMV by 24 weeks of age. Early CMV infection may be a risk factor for subsequent infant HIV infection through breastfeeding, pointing to the need for comprehensive approaches in order to achieve elimination of breastfeeding transmission of HIV.

AB - Background: Cytomegalovirus (CMV) infection can be acquired in utero or postnatally through horizontal transmission and breastfeeding. The effect of postnatal CMV infection on postnatal HIV transmission is unknown. Methods: The Breastfeeding, Antiretrovirals and Nutrition study, conducted in Malawi, randomized 2369 mothers and their infants to three antiretroviral prophylaxis arms - mother (triple regimen), infant (nevirapine), or neither - for 28 weeks of breastfeeding, followed by weaning. Stored plasma and peripheral blood mononuclear cell specimens were available for 492 infants at 24 weeks and were tested with CMV PCR. Available samples from infants who were CMV PCR-positive at 24 weeks were also tested at birth (N = 242), and from infants PCR-negative at 24 weeks were tested at 48 weeks (N = 96). Cox proportional-hazards models were used to determine if CMV infection was associated with infant morbidity, mortality, or postnatal HIV acquisition. Results: At 24 weeks of age, CMV DNA was detected in 345/492 infants (70.1%); the estimated congenital CMV infection rate was 2.3%, and the estimated rate of CMV infection at 48 weeks was 78.5%. CMV infection at 24 weeks was associated with subsequent HIV acquisition through breastfeeding or infant death between 24 and 48 weeks of age (hazard ratio 4.27, P = 0.05). Conclusion: Most breastfed infants of HIV-infected mothers in this resource-limited setting are infected with CMV by 24 weeks of age. Early CMV infection may be a risk factor for subsequent infant HIV infection through breastfeeding, pointing to the need for comprehensive approaches in order to achieve elimination of breastfeeding transmission of HIV.

KW - breastfeeding

KW - cytomegalovirus

KW - HIV

KW - infant

KW - mother-to-child transmission

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U2 - 10.1097/QAD.0000000000000617

DO - 10.1097/QAD.0000000000000617

M3 - Article

C2 - 25985405

AN - SCOPUS:84928543126

VL - 29

SP - 831

EP - 836

JO - AIDS

JF - AIDS

SN - 0269-9370

IS - 7

ER -