Cytomegalovirus infection in HIV-infected versus non-infected infants and HIV disease progression in Cytomegalovirus infected versus non infected infants early treated with cART in the ANRS 12140-Pediacam study in Cameroon.
The outcome of CMV/HIV co-infection in infants treated early with combined antiretroviral therapy (cART) in resource-limited settings has not been described. We aimed to estimate the prevalence and identify factors associated with early CMV infection in HIV-infected and non-infected infants included in a study in Cameroon, and to compare HIV disease progression and survival after 1 year of early cART, following infants' CMV status.



HIV-infected infants followed from birth or from HIV diagnosis before 7 months old and HIV-uninfected infants born to HIV-infected or uninfected mothers were tested for CMV at a median age of 4.0 months [Interquartile range (IQR): 3.4-4.9]. Multivariable logistic regression was performed to identify factors associated with CMV infection. Early cART was offered to HIV-infected infants: mortality, immunological and virological outcomes were assessed.



Three hundred and sixty-nine infants were tested. The proportion of infants infected with CMV at baseline was significantly higher in HIV-infected than in HIV-uninfected groups (58.9% (86/146) vs 30.0% (67/223), p < 0.001). At baseline, median CMV viral load was higher in HIV-infected (3.7 log copies/ml [IQR; 3.1-4.3]) than in HIV-uninfected infants (2.8 log copies [IQR; 2.1-3.4], p < 0.001). cART was initiated in 90% of HIV-infected infants (132/146) at a median age of 4.0 months (IQR; 3.2-5.9); in this sub-group CMV infection was independently associated with being followed from the time of HIV diagnosis rather than from birth (aOR = 3.1, 95%CI [1.2-8.0]), born to a non-single mother (aOR = 3.4[1.4-8.1]), and breastfeeding (aOR = 7.3 [2.7-19.4]). HIV-infected infants were retested after a median of 7.1 months [4.8-9.5]: CMV was undetectable in 37 of the 61 (60.7%) initially CMV-infected cases and became detectable in 8 of the 38 (21.1%) initially CMV-negative cases. After 1 year of cART, the probability of death (0.185 vs 0.203; p = 0.75), the proportion of cases with HIV RNA viral load <400 copies/ml (75.5% vs 61.5%; p = 0.17) and the mean CD4 percentage increase (10.97% vs 6.88%; p = 0.15) did not differ between CMV+ and CMV- infants.



We observed a high prevalence of CMV infection among HIV-infected infants. Early initiation of cART may have limited the negative impact of CMV even in the absence of specific anti-CMV treatment.
Virology Service, Centre Pasteur of Cameroon, Member of the International Network of Pasteur Institutes, P.O. Box 31076, Yaounde, Cameroon. anfumbom25@yahoo.com.
Anfumbom K W
AK
Kfutwah
Virology Service, Centre Pasteur of Cameroon, Member of the International Network of Pasteur Institutes, P.O. Box 31076, Yaounde, Cameroon.
Paul Alain T
PA
Ngoupo
Epidemiology and Public Health Service, Centre Pasteur of Cameroon, Member of the International Network of Pasteur Institutes, Yaounde, Cameroon.
Casimir Ledoux
CL
Sofeu
Pediatric Day Clinic, Mother and Child Center of the Chantal Biya Foundation, Yaounde, Cameroon.
Francis Ateba
FA
Ndongo
Pediatric Day Clinic, Mother and Child Center of the Chantal Biya Foundation, Yaounde, Cameroon.
Georgette
G
Guemkam
Pediatric Service, Hospital Center Essos, Yaounde, Cameroon.
Suzie Tetang
ST
Ndiang
Epidemiology and Public Health Service, Centre Pasteur of Cameroon, Member of the International Network of Pasteur Institutes, Yaounde, Cameroon.
Félicité
F
Owona
Day Clinic, Laquintinie Hospital, Douala, Cameroon.|Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon.
Ida Calixte
IC
Penda
Epidemiology and Public Health Service, Centre Pasteur of Cameroon, Member of the International Network of Pasteur Institutes, Yaounde, Cameroon.
Patrice
P
Tchendjou
Assistance Publique des Hôpitaux de Paris, Laboratoire de Virologie, Hôpital Necker, Paris, France.|Université Paris 5 René Descartes, URF de Médecine, Paris, France.
Christine
C
Rouzioux
Equipe 4 (VIH et IST)-INSERM U1018 (CESP), Le Kremlin Bicêtre, France.|Assistance Publique des Hôpitaux de Paris, Service d'Epidémiologie et de Santé Publique, Hôpital de Bicêtre, Le Kremlin Bicêtre, France.|Université de Paris Sud 11, Paris, France.
Josiane
J
Warszawski
Assistance Publique des Hôpitaux de Paris, Pédiatrie Générale, Hôpital Robert Debré, Paris, France.|Université Paris 7 Denis Diderot, Paris Sorbonne Cité, Paris, France.|INSERM UMR 1123, ECEVE, Paris, France.
Albert
A
Faye
Epidemiology and Public Health Service, Centre Pasteur of Cameroon, Member of the International Network of Pasteur Institutes, Yaounde, Cameroon. tejiokem@pasteur-yaounde.org.|Equipe 4 (VIH et IST)-INSERM U1018 (CESP), Le Kremlin Bicêtre, France. tejiokem@pasteur-yaounde.org.|, P.O. Box 1274, Yaounde, Cameroon. tejiokem@pasteur-yaounde.org.
Mathurin Cyrille
MC
Tejiokem
D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002163:Cameroon / Q000453:epidemiology; D016022:Case-Control Studies; D060085:Coinfection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D003906:Developing Countries; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D044966:Anti-Retroviral Agents
Co-infection; Cytomegalovirus; Early treated HIV-infected infants; Human Immunodeficiency Virus