Department of Pediatrics, Division of Infectious Diseases, Maternal, Child, Adolescent/Adult Center for Infectious Diseases and Virology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States of America.
Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, and Maternal, Child, Adolescent/Adult Center for Infectious Diseases and Virology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States of America.
PLoS One. 2020 Feb 13;15(2):e0228900. doi: 10.1371/journal.pone.0228900. eCollection 2020.
CMV infection of the fetus or neonate can lead to devastating disease, and there are no effective prevention strategies to date. Vitamin D is a potent immunomodulator, supports antiviral immune responses, and plays an important role in placental immunity.
Retrospective cohort study to evaluate the impact of low maternal vitamin D on congenital and early postnatal transmission of CMV among HIV-infected, non-breastfeeding women and their HIV exposed but negative infants from an urban HIV clinic. Vitamin D panel was performed on stored maternal plasma obtained near time of delivery. Infant CMV testing at 0-6 months included urine and oral cultures, and/or serum polymerase chain reaction testing.
Cohort included 340 mother-infant pairs (births 1991-2014). Among 38 infants (11%) with a CMV+ test between 0-6 months, 4.7% (14/300) had congenital CMV transmission (CMV+ test 0-3 weeks), and 7.6% (24/315) had peri/postnatal CMV (CMV+ test >3 weeks-6 months). Women with lower calcitriol (1,25-dihydroxyvitamin D), the active form of vitamin D, were more likely to have an infant with congenital (OR 12.2 [95% CI 1.61-92.2] P = 0.02) and peri/postnatal (OR 9.84 [95% CI 2.63-36.8] P = 0.0007) infections in multivariate analyses, independent of maternal HIV viral load and CD4 count.
This study demonstrates an association between inadequate maternal calcitriol during pregnancy and increased congenital and early postnatal acquisition of CMV among non-breastfeeding women with HIV and their HIV negative infants.
胎儿或新生儿的巨细胞病毒（CMV）感染可导致毁灭性疾病，目前尚无有效的预防策略。维生素 D 是一种有效的免疫调节剂，支持抗病毒免疫反应，并在胎盘免疫中发挥重要作用。
对城市 HIV 诊所中 HIV 感染、非母乳喂养妇女及其 HIV 暴露但阴性婴儿的先天性和早期产后 CMV 传播的母体维生素 D 水平的影响进行回顾性队列研究。在接近分娩时对储存的母体血浆进行维生素 D 检测。对 0-6 个月大的婴儿进行 CMV 检测，包括尿液和口腔培养物，以及/或血清聚合酶链反应检测。
队列纳入了 340 对母婴（1991 年至 2014 年出生）。在 0-6 个月期间进行 CMV+检测的 38 名婴儿中（11%），有 4.7%（14/300）存在先天性 CMV 传播（CMV+检测 0-3 周），有 7.6%（24/315）存在围产期/产后 CMV（CMV+检测>3 周-6 个月）。具有较低的钙三醇（1,25-二羟维生素 D），即维生素 D 的活性形式的女性更有可能让婴儿患有先天性（比值比 12.2[95%置信区间 1.61-92.2]P=0.02）和围产期/产后（比值比 9.84[95%置信区间 2.63-36.8]P=0.0007）感染，这在多变量分析中独立于母体 HIV 病毒载量和 CD4 计数。
本研究表明，在 HIV 阳性非母乳喂养妇女及其 HIV 阴性婴儿中，母体怀孕期间钙三醇不足与先天性和早期产后获得 CMV 之间存在关联。
