title: Decreased risk of congenital cytomegalovirus infection in children born to HIV-1-infected mothers in the era of highly active antiretroviral therapy.
abstract: BACKGROUND
  We evaluated the prevalence of congenital cytomegalovirus (CMV) infection before and after highly active antiretroviral therapy (HAART) availability among neonates born to human immunodeficiency virus type 1 (HIV-1)-infected mothers. We also identified maternal risk factors associated with in utero CMV transmission.
  
  
  METHODS
  Routine screening for congenital CMV infection was performed from 1993 through 2004 in children born to HIV-1-infected mothers included in the French Perinatal Cohort (Enquête Périnatale Française). Interpretable tests on urine samples collected within the first 10 days of life were available for 4797 of the 7563 live-born infants. Prevalence was estimated for different time periods. Univariate and multivariate logistic regression analyses were performed to identify factors associated with CMV transmission in the HAART era.
  
  
  RESULTS
  Among live-born children, the overall prevalence of CMV infection was 2.3% (95% confidence interval, 1.9%-2.8%). Prevalence was higher among HIV-1-infected neonates (10.3%; 95% confidence interval, 5.6%-17.0%) than among HIV-1-uninfected neonates (2.2%; 95% confidence interval, 1.8%-2.7%; P < .01). Among HIV-1-uninfected neonates, the prevalence of CMV infection decreased over time, from 3.5% in 1997-1998 to 1.2% in 2003-2004. Delivery period, maternal age, time at antiretroviral treatment initiation, and maternal CD4(+) cell count <200 cells/mm(3) close to delivery were independently associated with CMV infection in logistic regression analysis. The percentage of symptomatic CMV infections was 23.1% among HIV-1-infected newborns and 6.7% among HIV-1-uninfected neonates.
  
  
  CONCLUSIONS
  The prevalence of congenital CMV infection was high and associated with high morbidity rates among HIV-1-infected neonates. Conversely, the prevalence of CMV infection decreased over time among neonates not infected with HIV-1, reaching levels similar to those observed in the general population, following the introduction and increasing use of HAART for prevention of mother-to-child HIV-1 transmission.
authors.affiliation: Institut National de Santé et de Recherche Médicale, Institut National Etudes Démographiques U822, IFR69, Le Kremlin-Bicêtre, France.
authors.forename: Gaelle
authors.initials: G
authors.lastname: Guibert
authors.forename: Josiane
authors.initials: J
authors.lastname: Warszawski
authors.forename: Jerome
authors.initials: J
authors.lastname: Le Chenadec
authors.forename: Stephane
authors.initials: S
authors.lastname: Blanche
authors.forename: Yassine
authors.initials: Y
authors.lastname: Benmebarek
authors.forename: Laurent
authors.initials: L
authors.lastname: Mandelbrot
authors.forename: Rolland
authors.initials: R
authors.lastname: Tubiana
authors.forename: Christine
authors.initials: C
authors.lastname: Rouzioux
authors.forename: Marianne
authors.initials: M
authors.lastname: Leruez-Ville
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D005260:Female; D005602:France; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D015995:Prevalence; D012307:Risk Factors; D014556:Urine / Q000821:virology; D055815:Young Adult