Cytomegalovirus Urinary Shedding in HIV-infected Pregnant Women and Congenital Cytomegalovirus Infection.

Publication Type:

Journal Article

Source:

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2017)

Abstract:

Background: Cytomegalovirus (CMV) urinary shedding in HIV-infected pregnant women 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, 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=0.02). Overall, ten 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=0.0001). Women with CMV viruria had significantly higher rates of HIV perinatal transmission (29.2% vs. 8.1%, p=0.002). They were 5 times (aOR=5.6, 95% 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.