Kourtis Athena P, Wiener Jeffrey, Chang Tiffany S, Dollard Sheila C, Amin Minal M, Ellington Sascha, Kayira Dumbani, van der Horst Charles, Jamieson Denise J
U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Clin Vaccine Immunol. 2015 Dec;22(12):1222-6. doi: 10.1128/CVI.00460-15. Epub 2015 Sep 30.
Cytomegalovirus (CMV) infection is common among infants of HIV-infected mothers in resource-limited settings. We examined the prevalence and timing of infant CMV infection during the first year of life using IgG antibody and avidity among HIV-exposed infants in Malawi and correlated the results with the presence of detectable CMV DNA in the blood. The Breastfeeding, Antiretrovirals and Nutrition (BAN) study randomized 2,369 mothers and their infants to maternal antiretrovirals, infant nevirapine, or neither for 28 weeks of breastfeeding, followed by weaning. Stored plasma specimens were tested for CMV IgG and antibody avidity from a random subset of infants who had been previously tested with blood CMV PCR and had available specimens at birth and at 24 and 48 weeks of age. Ninety-four of 127 infants (74.0%) tested at 24 weeks of age had CMV IgG of low or intermediate avidity, signifying primary CMV infections. An additional 22 infants (17.3%) had IgG of high avidity; 19 of them had CMV DNA detected in their blood, indicating infant infections. Taken together, these results show that the estimated prevalence of CMV infection at 24 weeks was 88.9%. By 48 weeks of age, 81.3% of infants had anti-CMV IgG; most of them (70.9%) had IgG of high avidity. The CMV serology and avidity testing, combined with the PCR results, confirmed a high rate of primary CMV infection by 6 months of life among breastfeeding infants of HIV-infected mothers. The CMV PCR in blood detected most, but not all, infant CMV infections.
在资源有限的环境中，巨细胞病毒（CMV）感染在感染HIV的母亲所生婴儿中很常见。我们利用IgG抗体和亲和力检测了马拉维HIV暴露婴儿出生后第一年中CMV感染的患病率和时间，并将结果与血液中可检测到的CMV DNA的存在情况相关联。母乳喂养、抗逆转录病毒药物和营养（BAN）研究将2369名母亲及其婴儿随机分为接受母亲抗逆转录病毒药物组、婴儿奈韦拉平组或两组均不接受组，进行为期28周的母乳喂养，随后断奶。对之前接受过血液CMV PCR检测且在出生时、24周和48周龄时有可用样本的随机抽取的一组婴儿的储存血浆样本进行CMV IgG和抗体亲和力检测。在24周龄时接受检测的127名婴儿中，有94名（74.0%）的CMV IgG亲和力低或中等，表明为原发性CMV感染。另外22名婴儿（17.3%）的IgG亲和力高；其中19名婴儿血液中检测到CMV DNA，表明婴儿感染。综合来看，这些结果显示24周时CMV感染的估计患病率为88.9%。到48周龄时，81.3%的婴儿有抗CMV IgG；其中大多数（70.9%）的IgG亲和力高。CMV血清学和亲和力检测与PCR结果相结合，证实感染HIV的母亲所生母乳喂养婴儿在6个月大时原发性CMV感染率很高。血液中的CMV PCR检测到了大多数但并非所有婴儿CMV感染。
