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

Pediatric HIV/AIDS Cohort Study

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)
JournalJournal of Pediatrics
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Cytomegalovirus Infections
Cytomegalovirus
HIV
Parturition
Therapeutics
Hearing
Puerto Rico
Language Development
DNA-Directed DNA Polymerase
CD4 Lymphocyte Count
Viral Load
Blood Cells
Cohort Studies
Language
Mothers
Polymerase Chain Reaction

Keywords

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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

@article{3d070e1ca0bd45888cc4cf8a88c12807,
title = "Birth Prevalence of Congenital Cytomegalovirus Infection in HIV-Exposed Uninfected Children in the Era of Combination Antiretroviral Therapy",
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.",
keywords = "cART, cCMV, congenital, cytomegalovirus, HIV-exposed uninfected, prevalence, women living with HIV",
author = "{Pediatric HIV/AIDS Cohort Study} and Purswani, {Murli U.} and Russell, {Jonathan S.} and Monika Dietrich and Kathleen Malee and Spector, {Stephen A.} and Williams, {Paige L.} and Toni Frederick and Sandra Burchett and Sean Redmond and Hoffman, {Howard J.} and Peter Torre and Sonia Lee and Rice, {Mabel L.} and Yao, {Tzy Jyun} and Ellen Chadwick and Sanders, {Margaret Ann} and Scott Hunter and William Shearer and Mary Paul and Chivon McMullen-Jackson and Ruth Eser-Jose and Lynnette Harris and Baig, {Mahoobullah Mirza} and Alma Villegas and Lisa Gaye-Robinson and Cooley, {Jawara Dia} and James Blood and Patricia Garvie and William Borkowsky and Sandra Deygoo and Jennifer Lewis and Arry Dieudonne and Linda Bettica and Juliette Johnson and Karen Surowiec and Katherine Knapp and Kim Allison and Megan Wilkins and Jamie Russell-Bell and Nicolas Rosario and Lourdes Angeli-Nieves and Vivian Olivera and Stephan Kohlhoff and Ava Dennie and Jean Kaye and {Van Dyke}, Russell and Karen Craig and Patricia Sirois and Gwendolyn Scott and Anai Cuadra",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jpeds.2019.09.025",
language = "English (US)",
journal = "Journal of Pediatrics",
issn = "0022-3476",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Birth Prevalence of Congenital Cytomegalovirus Infection in HIV-Exposed Uninfected Children in the Era of Combination Antiretroviral Therapy

AU - Pediatric HIV/AIDS Cohort Study

AU - Purswani, Murli U.

AU - Russell, Jonathan S.

AU - Dietrich, Monika

AU - Malee, Kathleen

AU - Spector, Stephen A.

AU - Williams, Paige L.

AU - Frederick, Toni

AU - Burchett, Sandra

AU - Redmond, Sean

AU - Hoffman, Howard J.

AU - Torre, Peter

AU - Lee, Sonia

AU - Rice, Mabel L.

AU - Yao, Tzy Jyun

AU - Chadwick, Ellen

AU - Sanders, Margaret Ann

AU - Hunter, Scott

AU - Shearer, William

AU - Paul, Mary

AU - McMullen-Jackson, Chivon

AU - Eser-Jose, Ruth

AU - Harris, Lynnette

AU - Baig, Mahoobullah Mirza

AU - Villegas, Alma

AU - Gaye-Robinson, Lisa

AU - Cooley, Jawara Dia

AU - Blood, James

AU - Garvie, Patricia

AU - Borkowsky, William

AU - Deygoo, Sandra

AU - Lewis, Jennifer

AU - Dieudonne, Arry

AU - Bettica, Linda

AU - Johnson, Juliette

AU - Surowiec, Karen

AU - Knapp, Katherine

AU - Allison, Kim

AU - Wilkins, Megan

AU - Russell-Bell, Jamie

AU - Rosario, Nicolas

AU - Angeli-Nieves, Lourdes

AU - Olivera, Vivian

AU - Kohlhoff, Stephan

AU - Dennie, Ava

AU - Kaye, Jean

AU - Van Dyke, Russell

AU - Craig, Karen

AU - Sirois, Patricia

AU - Scott, Gwendolyn

AU - Cuadra, Anai

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - cART

KW - cCMV

KW - congenital

KW - cytomegalovirus

KW - HIV-exposed uninfected

KW - prevalence

KW - women living with HIV

UR - http://www.scopus.com/inward/record.url?scp=85074510130&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074510130&partnerID=8YFLogxK

U2 - 10.1016/j.jpeds.2019.09.025

DO - 10.1016/j.jpeds.2019.09.025

M3 - Article

C2 - 31668479

AN - SCOPUS:85074510130

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

ER -