Increased Cytomegalovirus Secretion and Risks of Infant Infection by Breastfeeding Duration From Maternal Human Immunodeficiency Virus Positive Compared to Negative Mothers in Sub-Saharan Africa.
BACKGROUND
Breastfeeding imparts beneficial immune protection and nutrition to infants for healthy growth, but it is also a route for human immunodeficiency virus (HIV) and human cytomegalovirus (HCMV) infection. In previous studies, we showed that HCMV adversely affects infant development in Africa, particularly with maternal HIV exposure. In this study, we analyzed infants risks for acquisition of HCMV infection from breastfeeding and compared HIV-positive and HIV-negative mothers.


METHODS
Two cohorts were studied in Zambia. (1) Two hundred sixty-one HIV-infected and HIV-uninfected mothers were compared for HCMV deoxyribonucleic acid (DNA) loads and genotypes (glycoprotein gO) in milk from birth to 4 months postpartum. (2) Maternally HIV-exposed and HIV-unexposed infants were compared for HCMV infection risk factors. The second cohort of 460 infants, from a trial of micronutrient-fortified complementary-food to breastfeeding, were studied between 6 and 18 months of age. Human cytomegalovirus seroprevalence was assayed, and logistic regression was used to calculate risk factors for HCMV infection, including maternal HIV exposure and breastfeeding duration.


RESULTS
Human cytomegalovirus was detected in breast milk from 3 days to 4 months postpartum, with significantly raised levels in HIV-positive women and independent of genotype. In infants, HCMV antibody seroprevalence was 83% by 18 months age. Longer breastfeeding duration increased infection risk in maternally HIV-unexposed (odds ratio [OR] = 2.69 for 18 months vs <12 months; 95% confidence interval [CI], 0.84-8.59; P = .03) and HIV-exposed infants (OR = 20.37 for >6 months vs never; 95% CI, 3.71-111.70; P < .001).


CONCLUSIONS
Prolonged breastfeeding, which is common in Africa, increased risk of HCMV infection in infants. Both HIV-positive and HIV-negative women had extended milk HCMV secretion. Women who were HIV-positive secreted higher HCMV levels, and for longer duration, with their children at increased infection risk. Human cytomegalovirus control is required to maintain health benefits of breastfeeding.
Faculties of Infectious and Tropical Diseases Virology.
Kunda G
KG
Musonda
Faculties of Infectious and Tropical Diseases.
Mary
M
Nyonda
Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, University of London, United Kingdom.
Suzanne
S
Filteau
Obstetrics Unit, University Teaching Hospital, Lusaka, Zambia.
Lackson
L
Kasonka
Virology.
Mwaka
M
Monze
Faculties of Infectious and Tropical Diseases.
Ursula A
UA
Gompels
D017954:Africa South of the Sahara; D001942:Breast Feeding; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000635:transmission*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D008895:Milk, Human / Q000821:virology; D009035:Mothers; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D019562:Viral Load
HCMV; HIV-exposed infants; breast milk; infant HIV; maternal HIV