Vertical Cytomegalovirus Transmission From HIV-Infected Women Randomized to Formula-Feed or Breastfeed Their Infants

Richardson, Barbra A.; John‐Stewart, Grace; Atkinson, Claire; Nduati, Ruth; Ásbjörnsdóttir, Kristjana; Boeckh, Michael; Overbaugh, Julie; Emery, Vincent; Slyker, Jennifer A.

doi:10.1093/infdis/jiv515

Cited by 24 publications

(20 citation statements)

References 32 publications

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“…This observation is consistent with reports from observational studies reporting lower rates of CMV transmission in cohorts following the introduction of HAART, 20 and our own observation of later CMV transmission in successive cohorts studied over secular time, who were exposed to increasingly efficacious PMTCT regimens. 9,11,29 Our study is also consistent with a study in Malawi that found no difference between breast milk CMV DNA levels at 4-6 weeks postpartum in HAART-treated women compared to women receiving single-dose NVP. 23 Our data suggest the risk of CMV transmission was modified through mechanisms distinct from reducing breast milk CMV levels, such as maternal antibodies.…”

Section: Discussionsupporting

confidence: 90%

“…In Kenya most HIV-exposed children acquire CMV in the first year of life, regardless of HIV status, 9 with breast milk a major route of transmission. 11 CMV DNA is found in the breast milk of nearly all HIVinfected women, and breast milk CMV DNA level is associated with the risk of infant infection. 12 During pregnancy, CMV reactivation is also common in the cervix and is associated with the risk of intrapartum CMV transmission.…”

Section: Introductionmentioning

confidence: 99%

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Maternal Highly Active Antiretroviral Therapy Reduces Vertical Cytomegalovirus Transmission But Does Not Reduce Breast Milk Cytomegalovirus Levels

Slyker

Richardson

Chung

et al. 2017

AIDS Research and Human Retroviruses

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Maternal Highly Active Antiretroviral Therapy Reduces Vertical Cytomegalovirus Transmission But Does Not Reduce Breast Milk Cytomegalovirus Levels

Slyker

Richardson

Chung

et al. 2017

AIDS Research and Human Retroviruses

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“…CMV may therefore act as an important pathogen in patients with impaired immunity whether this results from iatrogenic or HIV induced immunosuppression. The incidence of congenital or perinatal CMV is also greatly increased in women with underlying HIV infection …”

Section: Discussionmentioning

confidence: 99%

Estimation of the worldwide seroprevalence of cytomegalovirus: A systematic review and meta‐analysis

Zuhair

Smit

Wallis

et al. 2019

Reviews in Medical Virology

591

411

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Cytomegalovirus (CMV) infection does not usually produce symptoms when it causes primary infection, reinfection, or reactivation because these three types of infection are all controlled by the normal immune system. However, CMV becomes an important pathogen in individuals whose immune system is immature or compromised, such as the unborn child. Several vaccines against CMV are currently in clinical trials that aim to induce immunity in seronegative individuals and/or to boost the immunity of those with prior natural infection (seropositives). To facilitate estimation of the burden of disease and the need for vaccines that induce de novo immune responses or that boost pre-existing immunity to CMV, we conducted a systematic survey of the published literature to describe the global seroprevalence of CMV IgG antibodies. We estimated a global CMV seroprevalence of 83% (95%UI: 78-88) in the general population, 86% (95%UI: 83-89) in women of childbearing age, and 86% (95%UI: 82-89) in donors of blood or organs. For each of these three groups, the highest seroprevalence was seen in the World Health Organisation (WHO) Eastern Mediterranean region 90% (95%UI: 85-94) and the lowest in WHO European region 66% (95%UI: 56-74). These estimates of the worldwide CMV distribution will help develop national and regional burden of disease models and inform future vaccine development efforts.

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“…Women living with HIV have a higher risk of transmitting CMV than women without HIV, due to longer duration of CMV excretion and higher breast milk, cervical, and salivary CMV viral loads 40,41 . In the only randomised controlled trial of breastfeeding versus formula feeding, conducted among mothers living with HIV in Nairobi during the pre--antiretroviral therapy (ART) era, a secondary analysis of CMV transmission was undertaken in 138 breastfed and 134 formula--fed infants 42 . Overall, breastfed infants acquired CMV earlier than formula--fed infants (median age, 4.26 vs 9.87 months; P<0.001) and had a higher 1--year probability of CMV infection (0.89 vs 0.69; P<0.001), although the proportion with symptomatic infection was not reported.…”

Section: CMVmentioning

confidence: 99%

Transmission of CMV, HTLV-1, and HIV through breastmilk

Prendergast

Goga

Waitt

et al. 2019

The Lancet Child & Adolescent Health

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Breastfeeding is a critical child survival intervention. The potential for transmission of some viral infections from mother-to-child, however, presents the dilemma of how best to interpret the benefits and risks of breastfeeding in different settings. Here, we compare the transmission dynamics, risk factors and outcomes of infection with three chronic viruses transmitted through breast milk: cytomegalovirus (CMV), human T-cell lymphotropic virus type 1 (HTLV-1), and human immunodeficiency virus (HIV). We provide an overview of current intervention approaches and discuss scientific, policy and programming gaps in our understanding of these major global infections. Key messages: • Three viruses are known to be transmitted through breastfeeding and to result in chronic infection: CMV, HTLV-1 and HIV. • CMV transmission through breast milk mostly leads to subclinical infection, except in preterm infants in whom severe clinical disease can occur; the best preventive and treatment approaches in this group remain unclear and more data are needed on long-term sequelae. • HTLV-1 is restricted to specific geographic foci and can be transmitted from mother-to-child through breastfeeding in 10-25% of cases; the best preventive strategy is avoidance or shortening of breastfeeding where safe alternatives are available. • The absolute transmission risk of HIV through breastfeeding in the context of suppressive maternal antiretroviral therapy is now low, even over extended periods. • Guidance for infant feeding for women living with HIV varies by setting: in low-and middle-income countries, breastfeeding with suppressive ART and adherence support is recommended, while in high-income settings formula feeding is advised.

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Vertical Cytomegalovirus Transmission From HIV-Infected Women Randomized to Formula-Feed or Breastfeed Their Infants

Abstract: Preventing CMV acquisition may be a priority for HIV-exposed infants, but there is a narrow window of opportunity for intervention. Approaches that reduce maternal cervical and breast milk CMV reactivation may help delay infant infection.

Cited by 24 publications

References 32 publications

Maternal Highly Active Antiretroviral Therapy Reduces Vertical Cytomegalovirus Transmission But Does Not Reduce Breast Milk Cytomegalovirus Levels

Maternal Highly Active Antiretroviral Therapy Reduces Vertical Cytomegalovirus Transmission But Does Not Reduce Breast Milk Cytomegalovirus Levels

Estimation of the worldwide seroprevalence of cytomegalovirus: A systematic review and meta‐analysis

Transmission of CMV, HTLV-1, and HIV through breastmilk

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