Cytomegalovirus infection in human immunodeficiency virus type 1-infected children

Chandwani, Sulachni; Kaul, Aditya; Bebenroth, D; Kim, Mimi; John, David Di; Fidelia, Andre; Hassel, Annette; Borkowsky, William; Krasinski, Keith

doi:10.1097/00006454-199604000-00006

Cited by 53 publications

(44 citation statements)

References 18 publications

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“…However, studies of children and more recent quantitative analyses of CMV infection and CMV viremia in both children and adults have shown a correlation between CMV infection and an advanced stage of HIV-1 disease. 6,[25][26][27][28][29][30][31][32] Reports of simultaneous infection with HIV-1 and CMV among adult patients in whom rapidly progressive disease developed may, in fact, be analogous to the findings reported here. [33][34][35][36] CMV and HIV-1 can infect the same cells, and the cellular proteins and viral gene products of each virus can activate the other virus in vitro.…”

Section: Discussionsupporting

confidence: 67%

Cytomegalovirus Infection and HIV-1 Disease Progression in Infants Born to HIV-1–Infected Women

Kovács

Schluchter²,

Easley³

et al. 1999

N Engl J Med

247

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Background and Methods-Cytomegalovirus (CMV) has been implicated as a cofactor in the progression of human immunodeficiency virus type 1 (HIV-1) disease. We assessed 440 infants (75 of whom were HIV-1-infected and 365 of whom were not) whose CMV status was known, who were born to HIV-1-infected women, and who were followed prospectively. HIV-1 disease progression was defined as the presence of class C symptoms (according to the criteria of the Centers for Disease Control and Prevention [CDC]) or CD4 counts of less than 750 cells per cubic millimeter by 1 year of age and less than 500 cells per cubic millimeter by 18 months of age.

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Section: Discussionsupporting

confidence: 67%

Cytomegalovirus Infection and HIV-1 Disease Progression in Infants Born to HIV-1–Infected Women

Kovács

Schluchter²,

Easley³

et al. 1999

N Engl J Med

247

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“…While the increased morbidity and mortality among infants coinfected with HIV and CMV is well recognized (10)(11)(12)(13)(14), HIVexposed but uninfected infants may also be at increased risk for morbidity and mortality from CMV infection (15)(16)(17). A study in Zambia found that HIV-exposed infants who were CMV seropositive had decreased length for age, reduced head size, and lower psychomotor development than those who were CMV uninfected (5).…”

mentioning

confidence: 99%

Cytomegalovirus IgG Level and Avidity in Breastfeeding Infants of HIV-Infected Mothers in Malawi

Kourtis¹,

Wiener²,

Chang³

et al. 2015

Clin. Vaccine Immunol.

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dCytomegalovirus (CMV) infection is common among infants of HIV-infected mothers in resource-limited settings. We examined the prevalence and timing of infant CMV infection during the first year of life using IgG antibody and avidity among HIVexposed infants in Malawi and correlated the results with the presence of detectable CMV DNA in the blood. The Breastfeeding, Antiretrovirals and Nutrition (BAN) study randomized 2,369 mothers and their infants to maternal antiretrovirals, infant nevirapine, or neither for 28 weeks of breastfeeding, followed by weaning. Stored plasma specimens were tested for CMV IgG and antibody avidity from a random subset of infants who had been previously tested with blood CMV PCR and had available specimens at birth and at 24 and 48 weeks of age. Ninety-four of 127 infants ( C ytomegalovirus (CMV) infection is the most common congenital infection, with an estimated prevalence of Ͼ1% in resource-limited settings (1, 2). Approximately 10 to 20% of congenital CMV infections result in permanent deficits, including sensorineural hearing loss, vision loss, and mental and developmental disability (3). The postnatal acquisition of CMV can occur through horizontal transmission and through breastfeeding, with a high probability of transmission in infants fed with breast milk containing infectious virus (4, 5). The infants of HIV-infected mothers may have higher rates of congenital CMV infection, particularly if the mothers are immunocompromised (6). While postnatal transmission is thought to be generally benign in healthy full-term infants, premature infants or other groups of immunocompromised infants are at risk for more extensive disease and may also experience long-term cognitive delays (7-9).While the increased morbidity and mortality among infants coinfected with HIV and CMV is well recognized (10-14), HIVexposed but uninfected infants may also be at increased risk for morbidity and mortality from CMV infection (15-17). A study in Zambia found that HIV-exposed infants who were CMV seropositive had decreased length for age, reduced head size, and lower psychomotor development than those who were CMV uninfected (5). HIV is endemic in many African countries and the CMV childhood infection burden is high, which may have a substantial impact on child health in the region. It is therefore important to examine when infants acquire primary CMV infection in such settings.In a previous analysis, we reported, using blood CMV PCR, that Ͼ70% of infants of HIV-infected mothers had acquired CMV infection by 24 weeks of age (18). Given that blood is not the optimal sample source for CMV detection, it is possible that our findings underestimated the true incidence of CMV acquisition in the infants. We thus additionally performed CMV IgG antibody titer and avidity testing in the infant plasma specimens at different points in the infants' first year of life. The objectives of this study were to comprehensively assess the rate of CMV acquisition and to further characterize the time of CMV infection in HIV-exp...

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“…Also, the CMV prevalence of 41.4% in this study was higher than the respective 23.8% and 38.6% reported among Bulgarian [29] and Brazilian [30] hospitalized children of similar ages. In addition, the prevalence of acute CMV infection in this study was higher than the 15%-20% among HEU children [16] but lower than the 30%-40% among the HIV-infected children in the United States cohorts at six months of age [13]. The differences in the geographical locations and ethnicities, the varying socioeconomic conditions, differences in normative practices of breastfeeding, the diverse age at CMV diagnosis, the HIV status state, the different definitions ascribed to CMV diagnosis, and the differing risks of postnatal transmission of CMV that were found in our setting and those of others could explain the dissimilarities in the prevalence of CMV observed in our study and in those of others [2,3,13,15,16].…”

Section: Discussionmentioning

confidence: 82%

“…Complex interactions exist between HIV and CMV, including a shared mode of in utero, perinatal, and post-natal routes of transmission [11][12][13][14]; a higher rate of congenital CMV infection in HIV-infected infants [11][12][13][14]; an impaired containment of CMV replication among HIV-infected infants [15]; and a more severe course of HIV infection, accompanied by a higher rates of central nervous system complications [16]. Mortality is also higher in CMV-HIV co-infected infants [17], and poorer growth and development had been recorded even among HIVexposed uninfected (HEU) infants who were coinfected with CMV [18].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors of cytomegalovirus infection among HIV-infected and HIV-exposed uninfected infants in Nigeria

Anígilájé

Dabit

Nweke

et al. 2015

J Infect Dev Ctries

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Introduction: Cytomegalovirus (CMV) co-infection increases morbidity and mortality in human immunodeficiency virus (HIV) disease. There has been no study on CMV infection and its risk factors among Nigerian HIV-infected and/or HIV-exposed uninfected infants. Methodology: This was a cross-sectional cohort study at the Federal Medical Center, Makurdi, between January 2012 and March 2013. Acute CMV infection among consecutive three-month-old HIV-infected and HIV-exposed uninfected infants was determined using the enzyme-linked immunosorbent assay of the CMV immunoglobulin M (IgM). The relationship between acute CMV infections in the infants and the potential risk factors was tested using logistic regression analyses. Results: The prevalence of acute CMV infection was 41.4% (91/220), including 12.1% (11/91) and 87.9% (80/91) among the HIV-infected and the HIV-exposed uninfected infants, respectively. In multivariate logistic regression analyses, oropharyngeal candidiasis in the infants, HIV co-infection in the infants, maternal mastitis during breastfeeding, and the absence of maternal chronic CMV infections significantly increased the risk of acute CMV in the young infants. Conclusions: In our setting, concerted efforts to prevent and/or promptly treat oropharyngeal candidiasis and mastitis during breastfeeding may reduce the burden of CMV among HIV-infected and HIV-exposed uninfected infants. Public enlightenment on the mode of CMV transmission and its prevention is also important.

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Cytomegalovirus infection in human immunodeficiency virus type 1-infected children

Cited by 53 publications

References 18 publications

Cytomegalovirus Infection and HIV-1 Disease Progression in Infants Born to HIV-1–Infected Women

Cytomegalovirus Infection and HIV-1 Disease Progression in Infants Born to HIV-1–Infected Women

Cytomegalovirus IgG Level and Avidity in Breastfeeding Infants of HIV-Infected Mothers in Malawi

Prevalence and risk factors of cytomegalovirus infection among HIV-infected and HIV-exposed uninfected infants in Nigeria

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