title: Human cytomegalovirus infant infection adversely affects growth and development in maternally HIV-exposed and unexposed infants in Zambia.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV) and human cytomegalovirus (HCMV) coinfections have been shown to increase infant morbidity, mortality, and AIDS progression. In HIV-endemic regions, maternal HIV-exposed but HIV-uninfected infants, which is the majority of children affected by HIV, also show poor growth and increased morbidity. Although nutrition has been examined, the effects of HCMV infection have not been evaluated. We studied the effects of HCMV infection on the growth, development, and health of maternally HIV-exposed and unexposed infants in Zambia.
  
  
  METHODS
  Infants were examined in a cohort recruited to a trial of micronutrient-fortified complementary foods. HIV-infected mothers and infants had received perinatal antiretroviral therapy to prevent mother-to-child HIV transmission. Growth, development, and morbidity were analyzed by linear regression analyses in relation to maternal HIV exposure and HCMV infection, as screened by sera DNA for viremia at 6 months of age and by antibody for infection at 18 months.
  
  
  RESULTS
  All HCMV-seropositive infants had decreased length-for-age by 18 months compared with seronegative infants (standard deviation [z]-score difference: -0.44 [95% confidence interval {CI}, -.72 to -.17]; P = .002). In HIV-exposed infants, those who were HCMV positive compared with those who were negative, also had reduced head size (mean z-score difference: -0.72 [95% CI, -1.23 to -.22]; P = .01) and lower psychomotor development (Bayley test score difference: -4.1 [95% CI, -7.8 to -.5]; P = .03). HIV-exposed, HCMV-viremic infants were more commonly referred for hospital treatment than HCMV-negative infants. The effects of HCMV were unaffected by micronutrient fortification.
  
  
  CONCLUSIONS
  HCMV affects child growth, development, and morbidity of African infants, particularly in those maternally exposed to HIV. HCMV is therefore a risk factor for child health in this region.
authors.affiliation: Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, University of London, UK. ursula.gompels@lshtm.ac.uk
authors.forename: U A
authors.initials: UA
authors.lastname: Gompels
authors.forename: N
authors.initials: N
authors.lastname: Larke
authors.forename: M
authors.initials: M
authors.lastname: Sanz-Ramos
authors.forename: M
authors.initials: M
authors.lastname: Bates
authors.forename: K
authors.initials: K
authors.lastname: Musonda
authors.forename: D
authors.initials: D
authors.lastname: Manno
authors.forename: J
authors.initials: J
authors.lastname: Siame
authors.forename: M
authors.initials: M
authors.lastname: Monze
authors.forename: S
authors.initials: S
authors.lastname: Filteau
mesh_terms: D000914:Antibodies, Viral; D002657:Child Development; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000473:pathology* / Q000635:transmission*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D015024:Zambia / Q000453:epidemiology
chemical_list: D000914:Antibodies, Viral