Division of Medical Virology, Department of Clinical Laboratory Sciences, University of Cape Town.
Clin Infect Dis. 2014 May;58(10):1467-72. doi: 10.1093/cid/ciu096. Epub 2014 Feb 23.
A high rate of congenital cytomegalovirus (CMV) has been documented in human immunodeficiency virus (HIV)-exposed infants in industrialized settings, both in the pre- and post-highly active antiretroviral therapy (HAART) era. Only limited data on the birth prevalence of congenital CMV among infants of HIV-infected women on prenatal antiretroviral (ARV) prophylaxis are available from sub-Saharan Africa, despite a high prevalence of both infections. We evaluated the prevalence of congenital CMV in HIV-exposed infants in the Western Cape, South Africa.
HIV-infected mothers were recruited in the immediate postnatal period at a referral maternity hospital between April and October 2012. Maternal and infant clinical data and newborn saliva swabs were collected. Saliva swabs were assayed by real-time polymerase chain reaction for CMV. Data were analyzed using univariate and multivariate logistic regression analyses to determine specific demographic, maternal, and newborn characteristics associated with congenital CMV.
CMV was detected in 22 of 748 newborn saliva swabs (2.9%; 95% confidence interval [CI], 1.9%-4.4%). Overall, 96% of mothers used prenatal ARV prophylaxis (prenatal zidovudine, 43.9%; HAART, 52.1%). Maternal age, gestational age, prematurity (<37 weeks' gestation), type of ARV prophylaxis, length of ARV prophylaxis, birth weight, small for gestational age, and infant feeding choice were not significantly different between CMV-infected and -uninfected infants. Maternal CD4 count <200 cells/μL during pregnancy was independently associated with congenital CMV (adjusted odds ratio, 2.9; 95% CI, 1.2-7.3). A negative correlation between CMV load in saliva and maternal CD4 count was observed (r = -0.495, n = 22, P = .019).
The birth prevalence of congenital CMV was high despite prenatal ARV prophylaxis, and was associated with advanced maternal immunosuppression.
在工业化国家，无论是在高效抗逆转录病毒治疗（HAART）之前还是之后，人类免疫缺陷病毒（HIV）暴露的婴儿中都有很高的先天性巨细胞病毒（CMV）发生率。尽管感染率很高，但来自撒哈拉以南非洲的关于接受产前抗逆转录病毒（ARV）预防的 HIV 感染妇女所生婴儿先天性 CMV 出生流行率的资料有限。我们评估了南非西开普省 HIV 暴露婴儿的先天性 CMV 流行率。
在 2012 年 4 月至 10 月期间，在一家转诊妇产医院，在产后即刻期招募了 HIV 感染的母亲。收集了母婴临床数据和新生儿唾液拭子。通过实时聚合酶链反应检测唾液拭子 CMV。使用单变量和多变量逻辑回归分析来确定与先天性 CMV 相关的特定人口统计学、产妇和新生儿特征。
在 748 份新生儿唾液拭子中，有 22 份（2.9%；95%置信区间[CI]，1.9%-4.4%）检测到 CMV。总体而言，96%的母亲使用产前 ARV 预防（产前齐多夫定，43.9%；HAART，52.1%）。CMV 感染和未感染婴儿之间在母亲年龄、胎龄、早产（<37 周）、ARV 预防类型、ARV 预防持续时间、出生体重、小于胎龄和婴儿喂养选择方面无显著差异。妊娠期间母亲 CD4 计数<200 个细胞/μL 与先天性 CMV 独立相关（调整后的优势比，2.9；95%CI，1.2-7.3）。唾液中 CMV 载量与母亲 CD4 计数呈负相关（r = -0.495，n = 22，P =.019）。
尽管进行了产前 ARV 预防，但先天性 CMV 的出生流行率仍然很高，并且与晚期母体免疫抑制有关。
