肯尼亚 HIV 感染婴儿的急性巨细胞病毒感染。
Acute cytomegalovirus infection in Kenyan HIV-infected infants.
机构信息
MRC Human Immunology Unit, Oxford University, Oxford, UK.
出版信息
AIDS. 2009 Oct 23;23(16):2173-81. doi: 10.1097/QAD.0b013e32833016e8.
OBJECTIVE
Cytomegalovirus (CMV) coinfection may influence HIV-1 disease progression during infancy. Our aim was to describe the incidence of CMV infection and the kinetics of viral replication in Kenyan HIV-infected and HIV-exposed uninfected infants.
METHODS
HIV-1 and CMV plasma viral loads were serially measured in 20 HIV-exposed uninfected and 44 HIV-infected infants born to HIV-infected mothers. HIV-infected children were studied for the first 2 years of life, and HIV-exposed uninfected infants were studied for 1 year.
RESULTS
CMV DNA was detected frequently during the first months of life; by 3 months of age, CMV DNA was detected in 90% of HIV-exposed uninfected infants and 93% of infants who had acquired HIV-1 in utero. CMV viral loads were highest in the 1-3 months following the first detection of virus and declined rapidly thereafter. CMV peak viral loads were significantly higher in the HIV-infected infants compared with the HIV-exposed uninfected infants (mean 3.2 versus 2.7 log10 CMV DNA copies/ml, respectively, P = 0.03). The detection of CMV DNA persisted to 7-9 months post-CMV infection in both the HIV-exposed uninfected (8/17, 47%) and HIV-infected (13/18, 72%, P = 0.2) children. Among HIV-infected children, CMV DNA was detected in three of the seven (43%) surviving infants tested between 19 and 21 months post-CMV infection. Finally, a strong correlation was found between peak CMV and HIV-1 viral loads (rho = 0.40, P = 0.008).
CONCLUSION
Acute CMV coinfection is common in HIV-infected Kenyan infants. HIV-1 infection was associated with impaired containment of CMV replication.
目的
巨细胞病毒（CMV）合并感染可能会影响婴儿期的 HIV-1 疾病进展。我们旨在描述肯尼亚 HIV 感染和 HIV 暴露但未感染婴儿中 CMV 感染的发生率和病毒复制动力学。
方法
对 20 名 HIV 暴露但未感染和 44 名 HIV 感染的母亲所生婴儿的 HIV-1 和 CMV 血浆病毒载量进行了连续测量。对 HIV 感染儿童进行了生命前 2 年的研究，对 HIV 暴露但未感染婴儿进行了 1 年的研究。
结果
CMV DNA 在生命的头几个月中经常被检测到；在 3 个月龄时，90%的 HIV 暴露但未感染婴儿和在宫内感染 HIV-1 的婴儿中均检测到 CMV DNA。CMV 病毒载量在首次检测到病毒后的 1-3 个月内最高，此后迅速下降。与 HIV 暴露但未感染婴儿相比，HIV 感染婴儿的 CMV 病毒载量峰值明显更高（分别为平均 3.2 与 2.7log10CMV DNA 拷贝/ml，P=0.03）。在 HIV 暴露但未感染（8/17，47%）和 HIV 感染（13/18，72%，P=0.2）儿童中，CMV DNA 的检测均持续到 CMV 感染后 7-9 个月。在 HIV 感染儿童中，在 CMV 感染后 19-21 个月对 7 名存活婴儿中的 3 名进行了检测，发现 CMV DNA 被检测到。最后，发现 CMV 病毒载量峰值与 HIV-1 病毒载量之间存在很强的相关性（rho=0.40，P=0.008）。
结论
急性 CMV 合并感染在肯尼亚 HIV 感染婴儿中很常见。HIV-1 感染与 CMV 复制的控制受损有关。
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