title: Cytomegalovirus IgG Level and Avidity in Breastfeeding Infants of HIV-Infected Mothers in Malawi.
abstract: Cytomegalovirus (CMV) infection is common among infants of HIV-infected mothers in resource-limited settings. We examined the prevalence and timing of infant CMV infection during the first year of life using IgG antibody and avidity among HIV-exposed infants in Malawi and correlated the results with the presence of detectable CMV DNA in the blood. The Breastfeeding, Antiretrovirals and Nutrition (BAN) study randomized 2,369 mothers and their infants to maternal antiretrovirals, infant nevirapine, or neither for 28 weeks of breastfeeding, followed by weaning. Stored plasma specimens were tested for CMV IgG and antibody avidity from a random subset of infants who had been previously tested with blood CMV PCR and had available specimens at birth and at 24 and 48 weeks of age. Ninety-four of 127 infants (74.0%) tested at 24 weeks of age had CMV IgG of low or intermediate avidity, signifying primary CMV infections. An additional 22 infants (17.3%) had IgG of high avidity; 19 of them had CMV DNA detected in their blood, indicating infant infections. Taken together, these results show that the estimated prevalence of CMV infection at 24 weeks was 88.9%. By 48 weeks of age, 81.3% of infants had anti-CMV IgG; most of them (70.9%) had IgG of high avidity. The CMV serology and avidity testing, combined with the PCR results, confirmed a high rate of primary CMV infection by 6 months of life among breastfeeding infants of HIV-infected mothers. The CMV PCR in blood detected most, but not all, infant CMV infections.
authors.affiliation: U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA apk3@cdc.gov.
authors.forename: Athena P
authors.initials: AP
authors.lastname: Kourtis
authors.affiliation: U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wiener
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Tiffany S
authors.initials: TS
authors.lastname: Chang
authors.affiliation: U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Sheila C
authors.initials: SC
authors.lastname: Dollard
authors.affiliation: U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Minal M
authors.initials: MM
authors.lastname: Amin
authors.affiliation: U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Sascha
authors.initials: S
authors.lastname: Ellington
authors.affiliation: UNC Project, Lilongwe, Malawi.
authors.forename: Dumbani
authors.initials: D
authors.lastname: Kayira
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: van der Horst
authors.affiliation: U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology; D000915:Antibody Affinity; D001942:Breast Feeding; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood* / Q000276:immunology; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008295:Malawi / Q000453:epidemiology; D009035:Mothers; D019829:Nevirapine / Q000627:therapeutic use; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D015995:Prevalence
chemical_list: D019380:Anti-HIV Agents; D000914:Antibodies, Viral; D004279:DNA, Viral; D007074:Immunoglobulin G; D019829:Nevirapine