title: Cytomegalovirus Urinary Shedding in HIV-infected Pregnant Women and Congenital Cytomegalovirus Infection.
abstract: BACKGROUND
  Cytomegalovirus (CMV) urinary shedding in pregnant women infected with human immunodeficiency virus (HIV) was evaluated to determine whether it poses an increased risk for congenital CMV infection (cCMV).
  
  
  METHODS
  A subset of mother-infant pairs enrolled in the perinatal NICHD HPTN 040 study (distinguished by no antiretroviral use before labor) was evaluated. Maternal and infant urines were tested by qualitative real-time polymerase chain reaction (RT-PCR) for CMV DNA with quantitative RT-PCR performed on positive specimens.
  
  
  RESULTS
  Urine specimens were available for 260 women with 85.4% from the Americas and 14.6% from South Africa. Twenty-four women (9.2%) had detectable CMV viruria by qualitative PCR. Maternal CMV viruria was not associated with mean CD4 cell counts or HIV viral load but was associated with younger maternal age (P = .02). Overall, 10 of 260 infants (3.8%) had cCMV. Women with detectable peripartum CMV viruria were more likely to have infants with cCMV than those without: 20.8% (5/24) versus 2.1% (5/236), (P = .0001). Women with CMV viruria had significantly higher rates of HIV perinatal transmission (29.2% vs. 8.1%, P = .002). They were 5 times (adjusted odds ratio [aOR] = 5.6, 95% confidence interval [CI] 1.9-16.8) and nearly 30 times (aOR, 29.7; 95% CI, 5.4-164.2) more likely to transmit HIV and CMV to their infants, respectively. Maternal gonorrhea (aOR, 19.5; 95% CI, 2.5-151.3) and higher maternal HIV log10 viral load (OR, 2.8; 95% CI, 1.3-6.3) were also significant risk factors for cCMV.
  
  
  CONCLUSIONS
  In this cohort of HIV-infected pregnant women not on antiretrovirals, urinary CMV shedding was a significant risk factor for CMV and HIV transmission to infants.
  
  
  BACKGROUND
  NCT00099359.
authors.affiliation: David Geffen University of California, Los Angeles School of Medicine, Los Angeles, California.
authors.forename: Kristina
authors.initials: K
authors.lastname: Adachi
authors.affiliation: Westat, Rockville, Maryland.
authors.forename: Jiahong
authors.initials: J
authors.lastname: Xu
authors.affiliation: David Geffen University of California, Los Angeles School of Medicine, Los Angeles, California.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Ank
authors.affiliation: Office of the Global AIDS Coordinator, US Department of State, Washington, DC.
authors.forename: D Heather
authors.initials: DH
authors.lastname: Watts
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Mofenson
authors.affiliation: Hospital Geral de Nova Iguaçu.
authors.forename: Jose Henrique
authors.initials: JH
authors.lastname: Pilotto
authors.affiliation: Hospital Federal dos Servidores do Estado, Rio de Janeiro.
authors.forename: Esau
authors.initials: E
authors.lastname: Joao
authors.affiliation: Hospital Conceicao, Porto Alegre.
authors.forename: Breno
authors.initials: B
authors.lastname: Santos
authors.affiliation: Hospital Femina, Porto Alegre.
authors.forename: Rosana
authors.initials: R
authors.lastname: Fonseca
authors.affiliation: Irmandade da Santa Casa de Misericordia de Porto Alegre, Rio Grande do Sul.
authors.forename: Regis
authors.initials: R
authors.lastname: Kreitchmann
authors.affiliation: Federal University of Minas Gerais, Belo Horizonte, Minas Gerais.
authors.forename: Jorge
authors.initials: J
authors.lastname: Pinto
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Marisa M
authors.initials: MM
authors.lastname: Mussi-Pinhata
authors.affiliation: SAMRC and Perinatal HIV Research Unit, University of Witwatersrand.
authors.forename: Glenda
authors.initials: G
authors.lastname: Gray
authors.affiliation: Department of Obstetrics and Gynecology, Stellenbosch University/Tygerberg Hospital, Cape Town, South Africa.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Theron
authors.affiliation: Fundacao Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
authors.forename: Mariza G
authors.initials: MG
authors.lastname: Morgado
authors.affiliation: David Geffen University of California, Los Angeles School of Medicine, Los Angeles, California.
authors.forename: Yvonne J
authors.initials: YJ
authors.lastname: Bryson
authors.affiliation: Fundacao Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
authors.forename: Valdilea G
authors.initials: VG
authors.lastname: Veloso
authors.affiliation: David Geffen University of California, Los Angeles School of Medicine, Los Angeles, California.|Fielding School of Public Health, UCLA, Los Angeles, California.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Jack
authors.initials: J
authors.lastname: Moye
authors.affiliation: David Geffen University of California, Los Angeles School of Medicine, Los Angeles, California.
authors.forename: Karin
authors.initials: K
authors.lastname: Nielsen-Saines
mesh_terms: D000293:Adolescent; D000328:Adult; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000150:complications / Q000151:congenital / Q000652:urine / Q000821:virology; D004279:DNA, Viral / Q000235:genetics / Q000652:urine*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000652:urine / Q000821:virology; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D012307:Risk Factors; D019562:Viral Load; D017201:Virus Shedding; D055815:Young Adult
chemical_list: D004279:DNA, Viral
keywords: CMV viruria; HIV; HIV perinatal transmission; congenital CMV; pregnancy