巨细胞病毒，可能还有EB病毒，通过母乳排出与母乳喂养传播HIV-1有关。

Cytomegalovirus, and possibly Epstein-Barr virus, shedding in breast milk is associated with HIV-1 transmission by breastfeeding.

作者信息

Viljoen Johannes, Tuaillon Edouard, Nagot Nicolas, Danaviah Siva, Peries Marianne, Padayachee Prevashinee, Foulongne Vincent, Bland Ruth, Rollins Nigel, Newell Marie-Louise, van de Perre Philippe

机构信息

aAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa bInserm U1058, Université Montpellier 1 cCHRU de Montpellier, Département de Bactériologie-Virologie & Institut de Recherche en Biothérapie and Department of Medical Information, Montpellier, France dRoyal Hospital for Sick Children, Glasgow, UK eDepartment of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa fDepartment of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland gFaculty of Medicine, University of Southampton, Southampton, UK. *Marie-Louise Newell and Philippe van de Perre contributed equally to the writing of this article.

出版信息

AIDS. 2015 Jan 14;29(2):145-53. doi: 10.1097/QAD.0000000000000527.

DOI:10.1097/QAD.0000000000000527

PMID:25535751

Abstract

OBJECTIVE

Postnatal HIV-1 mother-to-child transmission (MTCT) occurs in spite of antiretroviral therapy. Co-infections in breast milk with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) are associated with increased HIV-1 shedding in this compartment. We investigated CMV levels and EBV detection in breast milk as potential risk factors for MTCT of HIV-1 via breastfeeding.

METHODS

Cell-free HIV-1 RNA, cell-associated HIV-1 DNA, CMV and EBV DNA were quantified in breast milk from 62 HIV-infected mothers and proven postnatal MTCT of HIV-1 via breastfeeding. Controls were 62 HIV-positive mothers with HIV-uninfected infants.

RESULTS

Median (interquartile range) CMV DNA viral load was significantly higher in cases [88,044 (18,586-233,904)] than in controls [11,167 (3221-31,152)] copies/10 breast milk cells (P < 0.001). Breast milk CMV DNA level correlated positively with breast milk HIV-1 RNA level in cases and controls. EBV DNA was detectable in a higher proportion of breast milk samples of cases (37.1%) than controls (16.1%; P = 0.009). HIV-1 MTCT was strongly associated with HIV-1 RNA shedding in breast milk and plasma. In multivariable analysis, every 1 log10 increase in breast milk CMV DNA was associated with a significant 2.5-fold greater odds of MTCT of HIV-1, independent of breast milk and plasma HIV-1 levels; the nearly three-fold increased risk of HIV-1 MTCT with breast milk EBV DNA detection did not reach significance.

CONCLUSION

We provide the first evidence of an independent association between CMV in breast milk, and postnatal MTCT of HIV-1. This association could fuel persistent shedding of HIV-1 in breast milk in women receiving antiretroviral therapy. EBV DNA detection in breast milk may also be associated with MTCT of HIV-1, but only marginally so.

摘要

目的

尽管进行了抗逆转录病毒治疗，但产后仍会发生HIV-1母婴传播（MTCT）。母乳中巨细胞病毒（CMV）和爱泼斯坦-巴尔病毒（EBV）的合并感染与该部位HIV-1脱落增加有关。我们研究了母乳中CMV水平和EBV检测情况，将其作为HIV-1通过母乳喂养发生母婴传播的潜在危险因素。

方法

对62名感染HIV的母亲的母乳进行无细胞HIV-1 RNA、细胞相关HIV-1 DNA、CMV和EBV DNA定量分析，并证实通过母乳喂养发生了产后HIV-1母婴传播。对照组为62名HIV阳性母亲及其未感染HIV的婴儿。

结果

病例组中CMV DNA病毒载量中位数（四分位间距）[88,044（18,586 - 233,904）]显著高于对照组[11,167（3221 - 31,152）]拷贝/10个母乳细胞（P < 0.001）。病例组和对照组中，母乳CMV DNA水平与母乳HIV-1 RNA水平呈正相关。病例组母乳样本中EBV DNA的检出比例（37.1%）高于对照组（16.1%；P = 0.009）。HIV-1母婴传播与母乳和血浆中HIV-1 RNA脱落密切相关。在多变量分析中，母乳CMV DNA每增加1 log10与HIV-1母婴传播几率显著增加2.5倍相关，与母乳和血浆HIV-1水平无关；母乳EBV DNA检测使HIV-1母婴传播风险增加近三倍，但未达到显著水平。