The detection of cytomegalovirus DNA in maternal plasma is associated with mortality in HIV-1-infected women and their infants.
OBJECTIVE
Cytomegalovirus (CMV) is an important pathogen in healthy neonates and individuals with human immunodeficiency virus (HIV-1). The objective of this study was to determine whether the detection of CMV DNA (CMV DNAemia) in maternal plasma was associated with mortality in HIV-1-infected women or their infants.


METHODS
A longitudinal study was designed to examine the relationship between maternal CMV DNAemia and maternal-infant mortality during 2 years postpartum. Sixty-four HIV-1-infected women and their infants were studied. CMV DNA loads were quantified in plasma from the mothers near the time of delivery. Baseline maternal CD4 cell counts, CD4%, HIV-1 RNA, and CMV DNAemia were evaluated as covariates of subsequent maternal or infant mortality in univariate and multivariate Cox regression.


RESULTS
CMV DNA was detected in 11/64 (17%) of the HIV-1-infected women. HIV-1 and CMV viral load were strongly correlated in CMV DNAemic women (rho = 0.84, P = 0.001). Detection of CMV DNAemia was associated with decreased maternal survival at 24 months postpartum (log-rank P = 0.006). Additionally, HIV-1-infected infants born to CMV DNAemic women had a four-fold increased risk of mortality during 24 months of follow-up. Maternal CMV DNAemia remained a significant risk factor for mortality in HIV-1-infected infants after adjusting for maternal CD4 cells/microl [adjusted hazard ratio (HR) = 4.3, confidence interval (CI) = 1.4-13], CD4% (HR = 3.2, CI = 1.0-10), HIV-1 viral load (HR = 4.1, CI = 1.4-12) or maternal death (HR = 3.7, CI = 1.0-13).


CONCLUSIONS
Maternal plasma CMV DNAemia identified a subgroup of Kenyan women and infants at high risk for death in the 2 years following delivery.
Slyker
Jennifer A
JA
MRC Human Immunology Unit, Oxford University, Oxford, UK. jslyker@u.washington.edu
Lohman-Payne
Barbara L
BL
Rowland-Jones
Sarah L
SL
Otieno
Phelgona
P
Maleche-Obimbo
Elizabeth
E
Richardson
Barbra
B
Farquhar
Carey
C
Mbori-Ngacha
Dorothy
D
Emery
Vincent C
VC
John-Stewart
Grace C
GC
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000635:transmission / Q000821:virology*; D000328:Adult; D018791:CD4 Lymphocyte Count; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000276:immunology / Q000635:transmission / Q000821:virology*; D004279:DNA, Viral / Q000097:blood; D018450:Disease Progression; D004812:Epidemiologic Methods; D005260:Female; D015497:HIV-1; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology / Q000821:virology*; D011379:Prognosis; D019562:Viral Load; D014766:Viremia / Q000276:immunology / Q000821:virology*; D055815:Young Adult
D004279:DNA, Viral