title: Vertical Cytomegalovirus Transmission From HIV-Infected Women Randomized to Formula-Feed or Breastfeed Their Infants.
abstract: BACKGROUND
  Cytomegalovirus (CMV) is associated with morbidity and mortality in human immunodeficiency virus (HIV)-exposed infants. We assessed the effect of and relative contribution of breastfeeding to CMV acquisition among infants delivered by HIV-infected mothers.
  
  
  METHODS
  Between 1993 and 1998 pregnant, HIV-infected women in Nairobi, Kenya, were randomly assigned to breastfeed or formula-feed their infants in an HIV transmission study. Women were allocated equally between treatment arms, and the study was not blinded. The primary endpoint of this nested study was time to infant CMV infection.
  
  
  RESULTS
  CMV infection was assessed in 138 breastfed and 134 formula-fed infants. Baseline characteristics were similar between arms. Breastfed infants acquired CMV earlier than formula-fed infants (median age of acquisition, 4.26 vs 9.87 months; P < .001) and had a higher 1-year probability of CMV infection (0.89 vs 0.69; P < .001). Breastfeeding was associated with a 1.6-fold increased risk of infant CMV acquisition independent of infant HIV status (multivariable hazard ratio, 1.61; 95% confidence interval, 1.20-2.16; P = .002). Approximately one third of CMV infections occurred during the peripartum period, with 40% acquired through breastfeeding and the remainder acquired through modes other than breast milk.
  
  
  CONCLUSIONS
  Preventing CMV acquisition may be a priority for HIV-exposed infants, but there is a narrow window of opportunity for intervention. Approaches that reduce maternal cervical and breast milk CMV reactivation may help delay infant infection.
authors.affiliation: Department of Biostatistics Department of Global Health Vaccine and Infectious Disease Division Public Health Sciences Division.
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.affiliation: Department of Global Health Department of Epidemiology Division of Allergy and Infectious Diseases, Department of Medicine Department of Pediatrics, University of Washington.
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
authors.affiliation: Institute for Immunity and Transplantation, University College, London.
authors.forename: Claire
authors.initials: C
authors.lastname: Atkinson
authors.affiliation: Department of Pediatrics and Child health, School of Medicine, University of Nairobi, Kenya.
authors.forename: Ruth
authors.initials: R
authors.lastname: Nduati
authors.affiliation: Department of Epidemiology.
authors.forename: Kristjana
authors.initials: K
authors.lastname: Ásbjörnsdóttir
authors.affiliation: Division of Allergy and Infectious Diseases, Department of Medicine Vaccine and Infectious Disease Division Clinical Research Division.
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
authors.affiliation: Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Julie
authors.initials: J
authors.lastname: Overbaugh
authors.affiliation: Department of Microbial and Cellular Sciences, University of Surrey, United Kingdom.
authors.forename: Vincent
authors.initials: V
authors.lastname: Emery
authors.affiliation: Department of Global Health.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Slyker
mesh_terms: D000328:Adult; D001942:Breast Feeding; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000150:complications / Q000635:transmission*; D004279:DNA, Viral / Q000097:blood / Q000302:isolation & purification; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D041943:Infant Formula; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D011247:Pregnancy; D012307:Risk Factors; D055815:Young Adult
chemical_list: D004279:DNA, Viral
keywords: HIV; co-infection; cytomegalovirus; infant; vertical transmission