Chang Tiffany S, Wiener Jeffrey, Dollard Sheila C, Amin Minal M, Ellington Sascha, Chasela Charles, Kayira Dumbani, Tegha Gerald, Kamwendo Deborah, Jamieson Denise J, van der Horst Charlie, Kourtis Athena P
aEmory University School of Medicine bUS Centers for Disease Control and Prevention, Atlanta, Georgia, USA cUNC Project, Lilongwe, Malawi dUniversity of North Carolina (UNC) at Chapel Hill, Chapel Hill, North Carolina, USA.
AIDS. 2015 Apr 24;29(7):831-6. doi: 10.1097/QAD.0000000000000617.
Cytomegalovirus (CMV) infection can be acquired in utero or postnatally through horizontal transmission and breastfeeding. The effect of postnatal CMV infection on postnatal HIV transmission is unknown.
The Breastfeeding, Antiretrovirals and Nutrition study, conducted in Malawi, randomized 2369 mothers and their infants to three antiretroviral prophylaxis arms - mother (triple regimen), infant (nevirapine), or neither - for 28 weeks of breastfeeding, followed by weaning. Stored plasma and peripheral blood mononuclear cell specimens were available for 492 infants at 24 weeks and were tested with CMV PCR. Available samples from infants who were CMV PCR-positive at 24 weeks were also tested at birth (N = 242), and from infants PCR-negative at 24 weeks were tested at 48 weeks (N = 96). Cox proportional-hazards models were used to determine if CMV infection was associated with infant morbidity, mortality, or postnatal HIV acquisition.
At 24 weeks of age, CMV DNA was detected in 345/492 infants (70.1%); the estimated congenital CMV infection rate was 2.3%, and the estimated rate of CMV infection at 48 weeks was 78.5%. CMV infection at 24 weeks was associated with subsequent HIV acquisition through breastfeeding or infant death between 24 and 48 weeks of age (hazard ratio 4.27, P = 0.05).
Most breastfed infants of HIV-infected mothers in this resource-limited setting are infected with CMV by 24 weeks of age. Early CMV infection may be a risk factor for subsequent infant HIV infection through breastfeeding, pointing to the need for comprehensive approaches in order to achieve elimination of breastfeeding transmission of HIV.
巨细胞病毒（CMV）感染可在子宫内获得，或出生后通过水平传播及母乳喂养感染。出生后CMV感染对出生后HIV传播的影响尚不清楚。
在马拉维进行的母乳喂养、抗逆转录病毒药物与营养研究，将2369名母亲及其婴儿随机分为三个抗逆转录病毒预防组——母亲（三联疗法）、婴儿（奈韦拉平）或两者均不使用——进行28周的母乳喂养，随后断奶。在24周时，有492名婴儿可获得储存的血浆和外周血单个核细胞标本，并进行CMV PCR检测。24周时CMV PCR阳性婴儿的可用样本在出生时也进行了检测（N = 242），24周时PCR阴性婴儿的样本在48周时进行了检测（N = 96）。采用Cox比例风险模型来确定CMV感染是否与婴儿发病、死亡或出生后HIV感染有关。
在24周龄时，345/492名婴儿（70.1%）检测到CMV DNA；估计先天性CMV感染率为2.3%，48周时CMV感染率估计为78.5%。24周时的CMV感染与出生后24至48周通过母乳喂养导致的后续HIV感染或婴儿死亡相关（风险比4.27，P = 0.05）。
在这种资源有限的环境中，大多数感染HIV母亲的母乳喂养婴儿在24周龄时感染了CMV。早期CMV感染可能是随后婴儿通过母乳喂养感染HIV的一个危险因素，这表明需要采取综合方法以实现消除HIV母乳喂养传播。
