Cytomegalovirus, and possibly Epstein–Barr virus, shedding in breast milk is associated with HIV-1 transmission by breastfeeding

Viljoen, Johannes; Tuaillon, Édouard; Nagot, Nicolas; Danaviah, Siva; Peries, Marianne; Padayachee, Prevashinee; Foulongne, Vincent; Bland, Ruth; Rollins, Nigel; Newell, Marie‐Louise; Perre, Philippe Van de

doi:10.1097/qad.0000000000000527

Cited by 39 publications

(29 citation statements)

References 43 publications

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“…Few studies on HIV transmission in CMV and HIV coinfected individuals have been conducted in Africa. Viljoen et al showed an independent association between CMV in breast milk and postnatal mother‐to‐child transmission of HIV. In Zimbabwe, Gantt et al also found an association between shedding of CMV and HIV in breast milk among 217 HIV‐infected breastfeeding women.…”

Section: Resultsmentioning

confidence: 99%

Review of cytomegalovirus coinfection in HIV-infected individuals in Africa

et al. 2016

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Section: Resultsmentioning

confidence: 99%

Review of cytomegalovirus coinfection in HIV-infected individuals in Africa

et al. 2016

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“…These observations all suggest shared risk factors for acquisition of the two viruses (e.g., lifestyle, behavior, demographics) as well as raising the possibility that HIV infection may be a direct risk factor for CMV acquisition in adults. The reciprocal scenario may also apply, as recent data from Africa suggest that CMV infection may be a risk factor for HIV transmission; a study in KwaZulu-Natal found an independent association between CMV in breast milk and postnatal mother-to-child transmission of HIV (Viljoen et al, 2015 ).…”

Section: Epidemiology Of CMV Mono- and Co-infectionmentioning

confidence: 99%

Ongoing burden of disease and mortality from HIV/CMV coinfection in Africa in the antiretroviral therapy era

et al. 2015

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Human Cytomegalovirus (CMV) is a well-recognized pathogen in the context of HIV infection, but since the roll out of ART, clinical and scientific interest in the problem of HIV/CMV coinfection has diminished. However, CMV remains a significant cofactor in HIV disease, with an influence on HIV acquisition, disease progression, morbidity, and mortality. Disease manifestations may be a result of direct interplay between the two viruses, or may arise as a secondary consequence of immune dysregulation and systemic inflammation. The problem is most relevant when the rates of coinfection are high, most notably in sub-Saharan Africa, and in children at risk of acquiring both infections early in life. Understanding the interplay between these viruses and developing strategies to diagnose, treat and prevent CMV should be a priority.

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“…In sub-Saharan Africa where HIV is endemic, maternal HCMV plasma deoxyribonucleic acid (DNA) was linked to increased mortality in both mother and child in Kenya [14]. Human cytomegalovirus secretion in milk is associated with infant HIV transmission in South Africa and Malawi [15, 16]. In maternally HIV-exposed Zambian children, who themselves remained HIV-negative, we showed that HCMV was associated with lower infant growth and psychomotor development [17].…”

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Increased Cytomegalovirus Secretion and Risks of Infant Infection by Breastfeeding Duration From Maternal Human Immunodeficiency Virus Positive Compared to Negative Mothers in Sub-Saharan Africa

et al. 2016

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BackgroundBreastfeeding imparts beneficial immune protection and nutrition to infants for healthy growth, but it is also a route for human immunodeficiency virus (HIV) and human cytomegalovirus (HCMV) infection. In previous studies, we showed that HCMV adversely affects infant development in Africa, particularly with maternal HIV exposure. In this study, we analyzed infants risks for acquisition of HCMV infection from breastfeeding and compared HIV-positive and HIV-negative mothers.MethodsTwo cohorts were studied in Zambia. (1) Two hundred sixty-one HIV-infected and HIV-uninfected mothers were compared for HCMV deoxyribonucleic acid (DNA) loads and genotypes (glycoprotein gO) in milk from birth to 4 months postpartum. (2) Maternally HIV-exposed and HIV-unexposed infants were compared for HCMV infection risk factors. The second cohort of 460 infants, from a trial of micronutrient-fortified complementary-food to breastfeeding, were studied between 6 and 18 months of age. Human cytomegalovirus seroprevalence was assayed, and logistic regression was used to calculate risk factors for HCMV infection, including maternal HIV exposure and breastfeeding duration.ResultsHuman cytomegalovirus was detected in breast milk from 3 days to 4 months postpartum, with significantly raised levels in HIV-positive women and independent of genotype. In infants, HCMV antibody seroprevalence was 83% by 18 months age. Longer breastfeeding duration increased infection risk in maternally HIV-unexposed (odds ratio [OR] = 2.69 for 18 months vs <12 months; 95% confidence interval [CI], 0.84–8.59; P = .03) and HIV-exposed infants (OR = 20.37 for >6 months vs never; 95% CI, 3.71–111.70; P < .001).ConclusionsProlonged breastfeeding, which is common in Africa, increased risk of HCMV infection in infants. Both HIV-positive and HIV-negative women had extended milk HCMV secretion. Women who were HIV-positive secreted higher HCMV levels, and for longer duration, with their children at increased infection risk. Human cytomegalovirus control is required to maintain health benefits of breastfeeding.

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Cytomegalovirus, and possibly Epstein–Barr virus, shedding in breast milk is associated with HIV-1 transmission by breastfeeding

Cited by 39 publications

References 43 publications

Review of cytomegalovirus coinfection in HIV-infected individuals in Africa

Review of cytomegalovirus coinfection in HIV-infected individuals in Africa

Ongoing burden of disease and mortality from HIV/CMV coinfection in Africa in the antiretroviral therapy era

Increased Cytomegalovirus Secretion and Risks of Infant Infection by Breastfeeding Duration From Maternal Human Immunodeficiency Virus Positive Compared to Negative Mothers in Sub-Saharan Africa

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