title: Risk of congenital cytomegalovirus infection among HIV-exposed uninfected infants is not decreased by maternal nelfinavir use during pregnancy.
abstract: BACKGROUND
  Congenital cytomegalovirus (cCMV) infection is common among infants born to HIV-infected women. Nelfinavir (NFV), an antiretroviral drug that is safe during pregnancy, inhibits CMV replication in vitro at concentrations that standard doses achieve in plasma. We hypothesized that infants born to women receiving NFV for prevention of mother-to-child transmission of HIV (PMTCT) would have a reduced prevalence of cCMV infection.
  
  
  METHODS
  The prevalence of cCMV infection was compared among HIV-uninfected infants whose HIV-infected mothers either received NFV for >4 weeks during pregnancy (NFV-exposed) or did not receive any NFV in pregnancy (NFV-unexposed). CMV PCR was performed on infant blood samples collected at <3 weeks from birth.
  
  
  RESULTS
  Of the 1,255 women included, 314 received NFV for >4 weeks during pregnancy and 941 did not receive any NFV during pregnancy. The overall prevalence of cCMV infection in the infants was 2.2%, which did not differ by maternal NFV use. Maternal CD4 T cell counts were inversely correlated with risk of cCMV infection, independent of the time NFV was initiated during gestation. Infants with cCMV infection were born 0.7 weeks earlier (P = 0.010) and weighed 170 g less (P = 0.009) than uninfected infants.
  
  
  CONCLUSIONS
  Among HIV-exposed uninfected infants, cCMV infection was associated with adverse perinatal outcomes. NFV use in pregnancy was not associated with protection against cCMV. Safe and effective strategies to prevent cCMV infection are needed.
authors.affiliation: Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.|Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Soren
authors.initials: S
authors.lastname: Gantt
authors.affiliation: Center for Biostatistics in AIDS Research, The Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Erin
authors.initials: E
authors.lastname: Leister
authors.affiliation: Center for Biostatistics in AIDS Research, The Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Denise L
authors.initials: DL
authors.lastname: Jacobsen
authors.affiliation: Sainte-Justine University Health Centre, Montreal, Québec, Canada.|University of Montreal, Montreal, Québec, Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Boucoiran
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.|University of Washington, Seattle, Washington.
authors.forename: Meei-Li
authors.initials: ML
authors.lastname: Huang
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.|University of Washington, Seattle, Washington.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Jerome
authors.affiliation: Institute for Development Research, Marseille, France.|The Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Gonzague
authors.initials: G
authors.lastname: Jourdain
authors.affiliation: Institute for Development Research, Marseille, France.|The Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ngo-Giang-Huong
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: Sandra
authors.initials: S
authors.lastname: Burchett
authors.affiliation: University of Washington, Seattle, Washington.|Seattle Children's Research Institute, Seattle, Washington.
authors.forename: Lisa
authors.initials: L
authors.lastname: Frenkel
mesh_terms: D000328:Adult; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000151:congenital* / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009035:Mothers; D019888:Nelfinavir / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D017320:HIV Protease Inhibitors; D019888:Nelfinavir
keywords: HIV-exposed uninfected infants; congenital cytomegalovirus infection; nelfinavir