Acute cytomegalovirus infection in Kenyan HIV-infected infants.
OBJECTIVE
Cytomegalovirus (CMV) coinfection may influence HIV-1 disease progression during infancy. Our aim was to describe the incidence of CMV infection and the kinetics of viral replication in Kenyan HIV-infected and HIV-exposed uninfected infants.


METHODS
HIV-1 and CMV plasma viral loads were serially measured in 20 HIV-exposed uninfected and 44 HIV-infected infants born to HIV-infected mothers. HIV-infected children were studied for the first 2 years of life, and HIV-exposed uninfected infants were studied for 1 year.


RESULTS
CMV DNA was detected frequently during the first months of life; by 3 months of age, CMV DNA was detected in 90% of HIV-exposed uninfected infants and 93% of infants who had acquired HIV-1 in utero. CMV viral loads were highest in the 1-3 months following the first detection of virus and declined rapidly thereafter. CMV peak viral loads were significantly higher in the HIV-infected infants compared with the HIV-exposed uninfected infants (mean 3.2 versus 2.7 log10 CMV DNA copies/ml, respectively, P = 0.03). The detection of CMV DNA persisted to 7-9 months post-CMV infection in both the HIV-exposed uninfected (8/17, 47%) and HIV-infected (13/18, 72%, P = 0.2) children. Among HIV-infected children, CMV DNA was detected in three of the seven (43%) surviving infants tested between 19 and 21 months post-CMV infection. Finally, a strong correlation was found between peak CMV and HIV-1 viral loads (rho = 0.40, P = 0.008).


CONCLUSIONS
Acute CMV coinfection is common in HIV-infected Kenyan infants. HIV-1 infection was associated with impaired containment of CMV replication.
Slyker
Jennifer A
JA
MRC Human Immunology Unit, Oxford University, Oxford, UK. jslyker@u.washington.edu
Lohman-Payne
Barbara L
BL
John-Stewart
Grace C
GC
Maleche-Obimbo
Elizabeth
E
Emery
Sandra
S
Richardson
Barbra
B
Dong
Tao
T
Iversen
Astrid Kn
AK
Mbori-Ngacha
Dorothy
D
Overbaugh
Julie
J
Emery
Vincent C
VC
Rowland-Jones
Sarah L
SL
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000453:epidemiology / Q000821:virology*; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000151:congenital / Q000453:epidemiology / Q000276:immunology*; D004279:DNA, Viral / Q000097:blood; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000276:immunology*; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D019562:Viral Load; D014779:Virus Replication / Q000502:physiology
D004279:DNA, Viral