Birth Prevalence of Congenital Cytomegalovirus Infection in HIV-Exposed Uninfected Children in the Era of Combination Antiretroviral Therapy

Murli U. Purswani, Jonathan S. Russell, Monika Dietrich, Kathleen Malee, Stephen A. Spector, Paige L. Williams, Toni Frederick, Sandra Burchett, Sean Redmond, Howard J. Hoffman, Peter Torre, Sonia Lee, Mabel L. Rice, Tzy Jyun Yao, Ellen Chadwick, Margaret Ann Sanders, Scott Hunter, William Shearer, Mary Paul, Chivon McMullen-JacksonRuth Eser-Jose, Lynnette Harris, Mahoobullah Mirza Baig, Alma Villegas, Lisa Gaye-Robinson, Jawara Dia Cooley, James Blood, Patricia Garvie, William Borkowsky, Sandra Deygoo, Jennifer Lewis, Arry Dieudonne, Linda Bettica, Juliette Johnson, Karen Surowiec, Katherine Knapp, Kim Allison, Megan Wilkins, Jamie Russell-Bell, Nicolas Rosario, Lourdes Angeli-Nieves, Vivian Olivera, Stephan Kohlhoff, Ava Dennie, Jean Kaye, Russell Van Dyke, Karen Craig, Patricia Sirois, Cecelia Hutto, Paige Hickman, Dan Marullo, Veronica Figueroa, Megan Loughran, Sharon Nichols, Elizabeth McFarland, Emily Barr, Christine Kwon, Carrie Glenny, Mobeen Rathore, Kristi Stowers, Saniyyah Mahmoudi, Nizar Maraqa, Rosita Almira, Karen Hayani, Lourdes Richardson, Renee Smith, Alina Miller, Gwendolyn Scott, Maria Mogollon, Gabriel Fernandez, Anai Cuadra, Mariam Davtyan, Jennifer Vinas, Guadalupe Morales-Avendano, Zoe M. Rodriguez, Lizmarie Torres, Nydia Scalley

Research output: Contribution to journalArticle

Abstract

Objectives: To estimate birth prevalence of congenital cytomegalovirus (cCMV) in HIV-exposed uninfected children born in the current era of combination antiretroviral therapy and describe cCMV-related neurodevelopmental and hearing outcomes. Study design: The Surveillance Monitoring for ART Toxicities cohort study follows HIV-exposed uninfected children at 22 sites in the US and Puerto Rico. Birth cCMV prevalence was estimated in a subset of participants who had blood pellets collected within three weeks of birth and underwent ≥1 of 6 assessments evaluating cognitive and language development including an audiologic examination between 1 and 5 years of age. Detection of CMV DNA by polymerase chain reaction testing of peripheral blood mononuclear cells was used to diagnose cCMV. Proportions of suboptimal assessment scores were compared by cCMV status using Fisher exact test. Results: Mothers of 895 eligible HIV-exposed uninfected children delivered between 2007 and 2015. Most (90%) were on combination antiretroviral therapy, 88% had an HIV viral load of ≤400 copies/mL, and 93% had CD4 cell counts of ≥200 cells/μL. Eight infants were diagnosed with cCMV, yielding an estimated prevalence of 0.89% (95% CI, 0.39%-1.75%). After adjusting for a sensitivity of 70%-75% for the testing method, projected prevalence was 1.2%-1.3%. No differences were observed in cognitive, language and hearing assessments by cCMV status. Conclusions: Although birth cCMV prevalence in HIV-exposed uninfected children born to women with well-controlled HIV is trending down compared with earlier combination antiretroviral therapy-era estimates, it is above the 0.4% reported for the general US population. HIV-exposed uninfected children remain at increased risk for cCMV.

Original languageEnglish (US)
Pages (from-to)82-87.e2
JournalJournal of Pediatrics
Volume216
DOIs
StatePublished - Jan 2020

Keywords

  • HIV-exposed uninfected
  • cART
  • cCMV
  • congenital
  • cytomegalovirus
  • prevalence
  • women living with HIV

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Purswani, M. U., Russell, J. S., Dietrich, M., Malee, K., Spector, S. A., Williams, P. L., Frederick, T., Burchett, S., Redmond, S., Hoffman, H. J., Torre, P., Lee, S., Rice, M. L., Yao, T. J., Chadwick, E., Sanders, M. A., Hunter, S., Shearer, W., Paul, M., ... Scalley, N. (2020). Birth Prevalence of Congenital Cytomegalovirus Infection in HIV-Exposed Uninfected Children in the Era of Combination Antiretroviral Therapy. Journal of Pediatrics, 216, 82-87.e2. https://doi.org/10.1016/j.jpeds.2019.09.025