在乌干达东部，与人类免疫缺陷病毒暴露但未感染婴儿早期感染 EBV 相关的临床和生物学因素。

Clinical and Biological Factors Associated With Early Epstein-Barr Virus Infection in Human Immunodeficiency Virus-Exposed Uninfected Infants in Eastern Uganda.

机构信息

Pathogenesis and Control of Chronic Infections, Institut national de la santé et de la recherche médicale (INSERM), Etablissement Français du Sang, University of Montpellier, Montpellier University Hospital CHU, Montpellier, Montpellier, France.

Center for International Health, University of Bergen, Bergen, Norway.

出版信息

Clin Infect Dis. 2021 Mar 15;72(6):1026-1032. doi: 10.1093/cid/ciaa161.

DOI:10.1093/cid/ciaa161

PMID:32067040

Abstract

BACKGROUND

Immune control of Epstein-Barr virus (EBV) infection is impaired in individuals with HIV. We explored maternal factors associated with EBV acquisition in HIV-exposed uninfected (HEU) infants and the relationship between EBV infection and serious adverse events (SAEs) during the first year of life.

METHODS

201 HEU infants from Uganda enrolled in the ANRS 12174 trial were tested for antiviral capsid antigen (anti-VCA) antibodies at week 50. Date of infection was estimated by testing EBV DNA at weeks 1, 6, 14, 26, 38, and 50 postpartum on dried blood spots.

RESULTS

Eighty-seven (43%) infants tested positive for anti-VCA IgG at week 50. Among the 59 infants positive for EBV DNA, 25% were infected within the first 26 weeks. Almost half (12%) were infected before week 14. Shedding of EBV in breast milk was associated with EBV DNA in maternal plasma (P = .009), HIV RNA detection (P = .039), and lower CD4 count (P = .001) and correlated with plasma EBV DNA levels (P = .002). EBV infant infection at week 50 was associated with shedding of EBV in breast milk (P = .009) and young maternal age (P = .029). Occurrence of a clinical SAE, including malaria and pneumonia, was associated with higher levels of EBV DNA in infants (P = .010).

CONCLUSIONS

By assessing EBV infection in HEU infants we observed that infection during the first year is determined by HIV and EBV maternal factors and that EBV DNA levels were higher among infants with clinical SAEs.

CLINICAL TRIALS REGISTRATION

NCT00640263.

摘要

背景

艾滋病毒（HIV）感染者的 EBV 感染免疫控制受损。我们探索了与 HIV 暴露未感染（HEU）婴儿 EBV 获得相关的母体因素，以及 EBV 感染与生命第一年严重不良事件（SAE）之间的关系。

方法

来自乌干达的 201 名 HEU 婴儿参加了 ANRS 12174 试验，在第 50 周时检测抗病毒衣壳抗原（抗-VCA）抗体。通过在产后第 1、6、14、26、38 和 50 周检测干血斑中的 EBV DNA，估计感染日期。

结果

87 名（43%）婴儿在第 50 周时抗-VCA IgG 检测呈阳性。在 59 名 EBV DNA 阳性的婴儿中，25%在最初 26 周内感染。近一半（12%）在第 14 周前感染。母乳中 EBV 的脱落与母血浆中的 EBV DNA（P=0.009）、HIV RNA 检测（P=0.039）以及较低的 CD4 计数（P=0.001）相关，与血浆 EBV DNA 水平相关（P=0.002）。第 50 周时婴儿的 EBV 感染与母乳中 EBV 的脱落（P=0.009）和母亲年龄较小（P=0.029）有关。临床 SAE 的发生，包括疟疾和肺炎，与婴儿 EBV DNA 水平较高有关（P=0.010）。