Meyer Sarah A, Westreich Daniel J, Patel Emily, Ehlinger Elizabeth P, Kalilani Linda, Lovingood Rachel V, Denny Thomas N, Swamy Geeta K, Permar Sallie R
Department of Medicine, Children's Hospital Boston, Boston, MA 02115, USA.
Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, NC 27599, USA.
Infect Dis Obstet Gynecol. 2014;2014:989721. doi: 10.1155/2014/989721. Epub 2014 Mar 3.
HIV-1 and CMV are important pathogens transmitted via breastfeeding. Furthermore, perinatal CMV transmission may impact growth and disease progression in HIV-exposed infants. Although maternal antiretroviral therapy reduces milk HIV-1 RNA load and postnatal transmission, its impact on milk CMV load is unclear. We examined the relationship between milk CMV and HIV-1 load (4-6 weeks postpartum) and the impact of antiretroviral treatment in 69 HIV-infected, lactating Malawian women and assessed the relationship between milk CMV load and postnatal growth in HIV-exposed, breastfed infants through six months of age. Despite an association between milk HIV-1 RNA and CMV DNA load (0.39 log(10) rise CMV load per log(10) rise HIV-1 RNA load, 95% CI 0.13-0.66), milk CMV load was similar in antiretroviral-treated and untreated women. Higher milk CMV load was associated with lower length-for-age (-0.53, 95% CI: -0.96, -0.10) and weight-for-age (-0.40, 95% CI: -0.67, -0.13) Z-score at six months in exposed, uninfected infants. As the impact of maternal antiretroviral therapy on the magnitude of postnatal CMV exposure may be limited, our findings of an inverse relationship between infant growth and milk CMV load highlight the importance of defining the role of perinatal CMV exposure on growth faltering of HIV-exposed infants.
人类免疫缺陷病毒1型（HIV-1）和巨细胞病毒（CMV）是通过母乳喂养传播的重要病原体。此外，围产期CMV传播可能会影响暴露于HIV的婴儿的生长和疾病进展。虽然母亲的抗逆转录病毒疗法可降低乳汁中HIV-1 RNA载量和产后传播，但它对乳汁中CMV载量的影响尚不清楚。我们研究了69名感染HIV的马拉维哺乳期妇女乳汁中CMV与HIV-1载量（产后4 - 6周）之间的关系以及抗逆转录病毒治疗的影响，并评估了乳汁中CMV载量与暴露于HIV的母乳喂养婴儿至6个月龄时产后生长之间的关系。尽管乳汁中HIV-1 RNA与CMV DNA载量之间存在关联（HIV-1 RNA载量每增加1个对数10，CMV载量增加0.39个对数10，95%可信区间为0.13 - 0.66），但接受抗逆转录病毒治疗和未接受治疗的妇女乳汁中CMV载量相似。在暴露但未感染的婴儿中，较高的乳汁CMV载量与6个月时较低的年龄别身长（-0.53，95%可信区间：-0.96，-0.10）和年龄别体重（-0.40，95%可信区间：-0.67，-0.13）Z评分相关。由于母亲的抗逆转录病毒疗法对产后CMV暴露程度的影响可能有限，我们关于婴儿生长与乳汁CMV载量呈负相关的研究结果凸显了确定围产期CMV暴露在暴露于HIV的婴儿生长发育迟缓中所起作用的重要性。
