Doyle M, Atkins J T, Rivera-Matos I R
Department of Pediatrics, University of Texas-Houston Medical School, Houston, USA.
Pediatr Infect Dis J. 1996 Dec;15(12):1102-6. doi: 10.1097/00006454-199612000-00010.
To determine the rate of in utero transmission of cytomegalovirus (CMV) in perinatally HIV-exposed infants and to determine whether coinfection with CMV in early life affects outcome.
Infants born to HIV-infected women between March, 1988, and March, 1995, were evaluated (n = 206). Congenital or in utero CMV infection was defined as a positive CMV culture or shell vial assay on urine obtained in the first 3 weeks of life. HIV-infected infants either had positive serology beyond 18 months of age or, for an infant younger than 18 months, had a positive HIV PCR or HIV culture on at least two separate occasions.
There were 30 HIV-infected and 171 uninfected infants (144 who seroreverted and 27 infants with at least 2 negative HIV PCR or culture results and normal immunologic studies during the first 6 months of age). Urine culture for CMV was obtained during the first 3 weeks of life on 154 infants: 24 of 30 (80%) HIV-infected infants; and 130 of 171 (76%) HIV-uninfected infants. Overall 10 of 154 (6.5%) infants were infected with CMV: 5 of 24 (21%) HIV-infected and 5 of 130 (3.8%) HIV-uninfected infants. The rate of in utero CMV infection was significantly higher in HIV-infected infants (P = 0.008). Dually infected infants were more immunosuppressed than their CMV-negative counterparts. At 3 months of age the percentage of CD4+ T lymphocytes (P = 0.0021) and CD4:CD8 ratios (P = 0.0018) were significantly lower in the CMV-infected infants than in the CMV-uninfected infants. At 6 months of age the absolute CD4+ T lymphocyte counts (P = 0.0038), percentage of CD4+ T lymphocytes (P = 0.044) and CD4:CD8 ratios (P = 0.037) were significantly lower in the CMV-infected infants. The mean survival of HIV-infected infants who were coinfected with CMV in early life (5 in utero and 1 perinatally infected infant identified at 7 weeks) was 24.77 months. Kaplan-Meier survival analysis indicated a trend toward decreased survival in the infants who were coinfected with CMV in early life (P = 0.088).
Congenital CMV infection is more common in HIV-infected infants than in HIV-uninfected infants. Infection with CMV in early life is associated with greater immunosuppression and may be associated with a more rapid progression of HIV infection in infants.
确定围产期暴露于HIV的婴儿中巨细胞病毒（CMV）的宫内传播率，并确定早期生命中CMV合并感染是否会影响结局。
对1988年3月至1995年3月期间HIV感染女性所生的婴儿进行评估（n = 206）。先天性或宫内CMV感染定义为出生后前3周尿液CMV培养或空斑试验阳性。HIV感染婴儿年龄超过18个月时血清学呈阳性，或者对于年龄小于18个月的婴儿，至少在两个不同时间点HIV PCR或HIV培养呈阳性。
有30名HIV感染婴儿和171名未感染婴儿（144名血清学转阴，27名婴儿在出生后前6个月至少有2次HIV PCR或培养结果阴性且免疫研究正常）。154名婴儿在出生后前3周进行了CMV尿液培养：30名HIV感染婴儿中的24名（80%）；171名未感染HIV婴儿中的130名（76%）。总体而言，154名婴儿中有10名（6.5%）感染了CMV：24名HIV感染婴儿中的5名（21%）和130名未感染HIV婴儿中的5名（3.8%）。HIV感染婴儿的宫内CMV感染率显著更高（P = 0.008）。双重感染婴儿比CMV阴性的婴儿免疫抑制更严重。在3个月大时，CMV感染婴儿的CD4+ T淋巴细胞百分比（P = 0.0021）和CD4:CD8比值（P = 0.0018）显著低于未感染CMV的婴儿。在6个月大时，CMV感染婴儿的CD4+ T淋巴细胞绝对计数（P = 0.0038）、CD4+ T淋巴细胞百分比（P = 0.044）和CD4:CD8比值（P = 0.037）显著更低。早期生命中合并感染CMV的HIV感染婴儿（5名宫内感染和1名出生时感染婴儿在7周时确诊）的平均生存期为24.77个月。Kaplan-Meier生存分析表明，早期生命中合并感染CMV的婴儿有生存下降的趋势（P = 0.088）。
先天性CMV感染在HIV感染婴儿中比在未感染HIV婴儿中更常见。早期生命中感染CMV与更严重的免疫抑制相关，可能与婴儿HIV感染进展更快有关。
