Compartmentalized Cytomegalovirus Replication and Transmission in the Setting of Maternal HIV-1 Infection
Date
2014Author
Slyker, Jennifer
Atkinson, Claire
Kristjana, Ásbjörnsdóttir
Alison, Roxby
Alison, Drake
Kiarie, James
Anna, Wald
Michael, Boeckh
Barbra, Richardson
Katherine, Odem-Davis
Grace, John-Stewart
Vincent, Emery
Language
enMetadata
Show full item recordAbstract
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.
URI
http://cid.oxfordjournals.org/content/early/2013/11/22/cid.cit727.shorthttp://hdl.handle.net/11295/72426
Publisher
University of Nairobi,
Subject
cytomegalovirushuman immunodeficiency virus
neonates
opportunistic infection
compartmentalization
Description
ARTICLE
Collections
- Faculty of Health Sciences (FHS) [10385]