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Cytomegalovirus infection in children with AIDS
L D Frenkel1, S Gaur, M Tsolia
1Department of Pediatrics, UMDNJ--Robert Wood Johnson Medical School, New Brunswick 08903-0019.
Insights
Cytomegalovirus (CMV) infection is more common in children with symptomatic perinatally acquired human immunodeficiency virus (HIV). Active CMV infection is linked to increased mortality in these children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Virology
Background:
- Perinatal human immunodeficiency virus (HIV) infection poses significant health challenges.
- Cytomegalovirus (CMV) is a common opportunistic infection in immunocompromised individuals.
Purpose of the Study:
- To investigate the impact of cytomegalovirus (CMV) infection on the progression of perinatally acquired HIV.
- To determine the association between CMV infection and mortality in children with HIV.
Main Methods:
- Evaluation of data from 38 children with perinatally acquired HIV, categorized by disease severity (P0, P1, P2).
- Serial urine cultures to detect CMV viruria.
- Analysis of clinical outcomes including mortality and microcephaly.
Main Results:
- CMV infection was significantly more prevalent in symptomatic HIV-infected children (P2 group) compared to asymptomatic (P1) or indeterminate (P0) groups.
- CMV viruria was detected in a higher proportion of children who died from HIV compared to survivors.
- A significant association was found between CMV infection and increased mortality among P2 children.
Conclusions:
- Active CMV infection is significantly more prevalent in children with symptomatic perinatally acquired HIV.
- CMV infection is associated with a higher risk of mortality in this vulnerable population.
Abstract:
Data for 38 children perinatally exposed to human immunodeficiency virus (HIV) were evaluated to determine the impact of cytomegalovirus (CMV) infection on the course of perinatally acquired HIV infection. Thirteen children belonged to the P0 (indeterminate) group, one to the P1 (asymptomatic) group, and 24 to the P2 (symptomatic) group, per the classification of the Centers for Disease Control. Of the 24 children in the P2 group, 10 died. The mean follow-up time was 22.8 months for the 10 children who died and 16.3 months for the 13 children in the P0 group. Serial cultures of urine were performed for all 38 patients. CMV was isolated from seven of 10 children who died and from four of 14 children who survived (P less than .05). Only one of the 13 P0 children was culture-positive for CMV, as compared with 11 of 24 P2 children (P less than .05). All CMV-infected children continued to demonstrate CMV viruria in serial cultures. The mean age at the time of the first culture positive for CMV was 13 months. Microcephaly was present in 15 (65%) of 23 P2 children but in none of the P0 and P1 children (P less than .05). Eight of 11 CMV-infected children were microcephalic; seven of 12 children not infected with CMV were microcephalic (P greater than .05). These data suggest that the prevalence of active CMV infection is significantly higher in P2 children than in P0 and P1 children. In addition, there is a significant association between CMV infection and mortality among P2 children.