title: CMV infection in a cohort of HIV-exposed infants born to mothers receiving antiretroviral therapy during pregnancy and breastfeeding.
abstract: Antiretroviral therapy has been shown to reduce rates of congenital CMV infection. Little information is available on the possible impact of antiretroviral therapy on postnatal breastfeeding-associated CMV infection acquisition. A cohort of 89 HIV-infected mothers and their children was studied. Women received antiretroviral therapy from week 25 of gestation until 6 months postpartum or indefinitely if meeting the criteria for treatment. All women were evaluated for CMV IgG presence and CMV DNA in breast milk. Children were tested for CMV infection by either the presence of IgM or the presence of CMV DNA in plasma at 1, 6 and 12 months and by the presence of IgG at 24 months. All mothers had high titers of CMV DNA in breast milk (5.7 log at Month 1 and 5.1 log at Month 6). Cumulative CMV infection rates were 60.3 % at Month 6, 69 % at Month 12 and 96.4 % at Month 24. There was a significant negative correlation between the duration of antiretroviral treatment during pregnancy and levels of CMV DNA in breast milk at Month 1 (P = 0.033). There was a trend for a correlation between high titers of CMV DNA in breast milk at 6 months and CMV infection at 6 months (P = 0.069). In this cohort, more than 95 % of the children had acquired CMV infection by 2 years of age. Besides breastfeeding, which played a major role, also horizontal transmission between 1 and 2 years was certainly relevant in determining CMV infection acquisition.
authors.affiliation: Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Vaile Regina Elena 299, 00161, Rome, Italy.
authors.forename: Maria Franca
authors.initials: MF
authors.lastname: Pirillo
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Liotta
authors.affiliation: Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Vaile Regina Elena 299, 00161, Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Andreotti
authors.affiliation: DREAM Program, Community of S. Egidio, Blantyre, Malawi.
authors.forename: Haswel
authors.initials: H
authors.lastname: Jere
authors.affiliation: DREAM Program, Community of S. Egidio, Blantyre, Malawi.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Sagno
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Scarcella
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Mancinelli
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Ersilia
authors.initials: E
authors.lastname: Buonomo
authors.affiliation: Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Vaile Regina Elena 299, 00161, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Amici
authors.affiliation: Department of Human Sciences, LUMSA University, Rome, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Marazzi
authors.affiliation: Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Vaile Regina Elena 299, 00161, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Vella
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Palombi
authors.affiliation: Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Vaile Regina Elena 299, 00161, Rome, Italy. marina.giuliano@iss.it.
authors.forename: Marina
authors.identifier: http://orcid.org/0000-0003-2789-7797
authors.initials: M
authors.lastname: Giuliano
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood; D001942:Breast Feeding; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000473:pathology* / Q000635:transmission*; D004279:DNA, Viral / Q000032:analysis; D018562:Disease Transmission, Infectious; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D008895:Milk, Human / Q000821:virology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D000914:Antibodies, Viral; D004279:DNA, Viral; D007074:Immunoglobulin G
keywords: Breastfeeding; Cytomegalovirus; HIV; Infant; Vertical transmission