dc.contributor.author | Slyker, Jennifer | |
dc.contributor.author | Atkinson, Claire | |
dc.contributor.author | Kristjana, Ásbjörnsdóttir | |
dc.contributor.author | Alison, Roxby | |
dc.contributor.author | Alison, Drake | |
dc.contributor.author | Kiarie, James | |
dc.contributor.author | Anna, Wald | |
dc.contributor.author | Michael, Boeckh | |
dc.contributor.author | Barbra, Richardson | |
dc.contributor.author | Katherine, Odem-Davis | |
dc.contributor.author | Grace, John-Stewart | |
dc.contributor.author | Vincent, Emery | |
dc.date.accessioned | 2014-07-10T08:30:39Z | |
dc.date.available | 2014-07-10T08:30:39Z | |
dc.date.issued | 2014 | |
dc.identifier.uri | http://cid.oxfordjournals.org/content/early/2013/11/22/cid.cit727.short | |
dc.identifier.uri | http://hdl.handle.net/11295/72426 | |
dc.description | ARTICLE | en_US |
dc.description.abstract | Background. Cytomegalovirus (CMV) infection is associated with adverse outcomes in human immunodeficiency virus (HIV)–exposed infants. Determinants of vertical CMV transmission in the setting of maternal HIV-1 infection are not well-defined.
Methods. CMV and HIV-1 levels were measured in plasma, cervical secretions, and breast milk of 147 HIV-1–infected women to define correlates of maternal CMV replication and infant CMV acquisition.
Results. Although few women had detectable CMV in plasma (4.8%), the majority had detectable CMV DNA in cervical secretions (66%) and breast milk (99%). There was a strong association between cervical CMV detection during pregnancy and later breast milk levels (β = 0.47; P = .005). Plasma HIV-1 level and CD4 counts were associated with CMV in the cervix and breast milk. However HIV-1 levels within the cervix and breast milk were not associated with CMV within these compartments. Maternal breast milk CMV levels (hazard ratio [HR], 1.4; P = .003) and maternal CD4 < 450 cells/mm3 (HR, 1.8; P = .008) were independently associated with infant CMV acquisition; each log10 increase in breast milk CMV was associated with a 40% increase in infant infection. The breast milk CMV level required to attain a 50% probability of CMV transmission increased with higher maternal CD4 counts, increasing from 3.55 log10 CMV DNA copies/mL at a CD4 count of 350 cells/mm3 to 5.50 log10 CMV DNA copies/mL at a CD4 count of 1000 cells/mm3.
Conclusions. Breast milk CMV levels and maternal CD4 count are major determinants of CMV transmission in the setting of maternal HIV-1. Maternal immune reconstitution or lowering breast milk CMV levels may reduce vertical CMV transmission. | en_US |
dc.language.iso | en | en_US |
dc.publisher | University of Nairobi, | en_US |
dc.subject | cytomegalovirus | en_US |
dc.subject | human immunodeficiency virus | en_US |
dc.subject | neonates | en_US |
dc.subject | opportunistic infection | en_US |
dc.subject | compartmentalization | en_US |
dc.title | Compartmentalized Cytomegalovirus Replication and Transmission in the Setting of Maternal HIV-1 Infection | en_US |
dc.type | Article | en_US |
dc.type.material | en | en_US |