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Clinical Trial
. 2017 Aug 1;65(3):405-413.
doi: 10.1093/cid/cix222.

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

Kristina Adachi  1 , Jiahong Xu  2 , Bonnie Ank  1 , D Heather Watts  3 , Lynne M Mofenson  4 , Jose Henrique Pilotto  5 , Esau Joao  6 , Breno Santos  7 , Rosana Fonseca  8 , Regis Kreitchmann  9 , Jorge Pinto  10 , Marisa M Mussi-Pinhata  11 , Glenda Gray  12 , Gerhard Theron  13 , Mariza G Morgado  14 , Yvonne J Bryson  1 , Valdilea G Veloso  14 , Jeffrey D Klausner  1   15 , Jack Moye  4 , Karin Nielsen-Saines  1 ; NICHD HPTN 040 Study Team
Collaborators, Affiliations
Clinical Trial

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

Kristina Adachi et al. Clin Infect Dis. .

Abstract

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.

Clinical trials registration number: NCT00099359.

Keywords: CMV viruria; HIV; HIV perinatal transmission; congenital CMV; pregnancy.

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Figures

Figure 1.
Figure 1.
Summary of observed study risk factors for maternal CMV viruria, congenital CMV infection (cCMV), and HIV perinatal transmission. Abbreviations: aOR, adjusted odds ratio; CI, confidence interval; CMV, cytomegalovirus; HIV, human immunodeficiency virus; OR, odds ratio.
See this image and copyright information in PMC

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