Kfutwah Anfumbom K W, Ngoupo Paul Alain T, Sofeu Casimir Ledoux, Ndongo Francis Ateba, Guemkam Georgette, Ndiang Suzie Tetang, Owona Félicité, Penda Ida Calixte, Tchendjou Patrice, Rouzioux Christine, Warszawski Josiane, Faye Albert, Tejiokem Mathurin Cyrille
Virology Service, Centre Pasteur of Cameroon, Member of the International Network of Pasteur Institutes, P.O. Box 31076, Yaounde, Cameroon.
Epidemiology and Public Health Service, Centre Pasteur of Cameroon, Member of the International Network of Pasteur Institutes, Yaounde, Cameroon.
BMC Infect Dis. 2017 Mar 23;17(1):224. doi: 10.1186/s12879-017-2308-x.
The outcome of CMV/HIV co-infection in infants treated early with combined antiretroviral therapy (cART) in resource-limited settings has not been described. We aimed to estimate the prevalence and identify factors associated with early CMV infection in HIV-infected and non-infected infants included in a study in Cameroon, and to compare HIV disease progression and survival after 1 year of early cART, following infants' CMV status.
HIV-infected infants followed from birth or from HIV diagnosis before 7 months old and HIV-uninfected infants born to HIV-infected or uninfected mothers were tested for CMV at a median age of 4.0 months [Interquartile range (IQR): 3.4-4.9]. Multivariable logistic regression was performed to identify factors associated with CMV infection. Early cART was offered to HIV-infected infants: mortality, immunological and virological outcomes were assessed.
Three hundred and sixty-nine infants were tested. The proportion of infants infected with CMV at baseline was significantly higher in HIV-infected than in HIV-uninfected groups (58.9% (86/146) vs 30.0% (67/223), p < 0.001). At baseline, median CMV viral load was higher in HIV-infected (3.7 log copies/ml [IQR; 3.1-4.3]) than in HIV-uninfected infants (2.8 log copies [IQR; 2.1-3.4], p < 0.001). cART was initiated in 90% of HIV-infected infants (132/146) at a median age of 4.0 months (IQR; 3.2-5.9); in this sub-group CMV infection was independently associated with being followed from the time of HIV diagnosis rather than from birth (aOR = 3.1, 95%CI [1.2-8.0]), born to a non-single mother (aOR = 3.4[1.4-8.1]), and breastfeeding (aOR = 7.3 [2.7-19.4]). HIV-infected infants were retested after a median of 7.1 months [4.8-9.5]: CMV was undetectable in 37 of the 61 (60.7%) initially CMV-infected cases and became detectable in 8 of the 38 (21.1%) initially CMV-negative cases. After 1 year of cART, the probability of death (0.185 vs 0.203; p = 0.75), the proportion of cases with HIV RNA viral load <400 copies/ml (75.5% vs 61.5%; p = 0.17) and the mean CD4 percentage increase (10.97% vs 6.88%; p = 0.15) did not differ between CMV+ and CMV- infants.
We observed a high prevalence of CMV infection among HIV-infected infants. Early initiation of cART may have limited the negative impact of CMV even in the absence of specific anti-CMV treatment.
在资源有限的环境中，接受早期联合抗逆转录病毒治疗（cART）的婴儿中巨细胞病毒（CMV）/人类免疫缺陷病毒（HIV）合并感染的结局尚未得到描述。我们旨在估计喀麦隆一项研究中HIV感染和未感染婴儿中早期CMV感染的患病率，并确定与之相关的因素，以及根据婴儿的CMV状态比较早期cART治疗1年后HIV疾病进展和生存情况。
对出生时或7个月前诊断为HIV感染的婴儿以及HIV感染或未感染母亲所生的未感染HIV的婴儿进行随访，在中位年龄4.0个月[四分位间距（IQR）：3.4 - 4.9]时检测CMV。进行多变量逻辑回归以确定与CMV感染相关的因素。为HIV感染的婴儿提供早期cART：评估死亡率、免疫和病毒学结局。
共检测了369名婴儿。HIV感染组基线时CMV感染婴儿的比例显著高于未感染HIV组（58.9%（86/146）对30.0%（67/223），p < 0.001）。基线时，HIV感染婴儿的CMV病毒载量中位数（3.7 log拷贝/ml [IQR；3.1 - 4.3]）高于未感染HIV的婴儿（2.8 log拷贝[IQR；2.1 - 3.4]，p < 0.001）。90%的HIV感染婴儿（132/146）在中位年龄4.0个月（IQR；3.2 - 5.9）时开始接受cART；在该亚组中，CMV感染与从HIV诊断时而非出生时开始随访（调整后比值比[aOR]=3.1，95%置信区间[CI][1.2 - 8.0]）、非单身母亲所生（aOR = 3.4[1.4 - 8.1]）以及母乳喂养（aOR = 7.3 [2.7 - 19.4]）独立相关。HIV感染婴儿在中位7.1个月[4.8 - 9.5]后再次检测：61例最初CMV感染病例中有37例（60.7%）CMV检测不到，38例最初CMV阴性病例中有8例（21.1%）CMV变得可检测到。cART治疗1年后，CMV阳性和阴性婴儿的死亡概率（0.185对0.203；p = 0.75）、HIV RNA病毒载量<400拷贝/ml的病例比例（75.5%对61.5%；p = 0.17）以及平均CD4百分比增加（10.97%对6.88%；p = 0.15）没有差异。
我们观察到HIV感染婴儿中CMV感染的患病率很高。即使在没有特异性抗CMV治疗的情况下，早期开始cART可能也限制了CMV的负面影响。
