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Congenital and postnatal CMV and EBV acquisition in HIV-infected Zimbabwean infants

Hlanai Gumbo1, Bernard Chasekwa1, James A Church2

  • 1Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.

Plos One
|December 19, 2014
PubMed

Insights

Cytomegalovirus (CMV) and Epstein Barr virus (EBV) co-infections are common in HIV-infected infants in sub-Saharan Africa. However, neither CMV nor EBV co-infection was found to increase mortality in these infants.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Virology

Background:

  • HIV-infected infants in sub-Saharan Africa experience rapid disease progression.
  • Co-infection with cytomegalovirus (CMV) or Epstein Barr virus (EBV) was hypothesized to increase mortality in this vulnerable population.

Purpose of the Study:

  • To investigate the prevalence of CMV and EBV co-infections in HIV-infected infants.
  • To determine the impact of CMV and EBV co-infections on mortality in HIV-infected infants.

Main Methods:

  • Real-time PCR was used to test 257 antiretroviral therapy-naïve HIV-infected infants for CMV and EBV at 6 weeks of age.
  • Birth samples were analyzed when available to differentiate congenital from postnatal infections.
  • Kaplan-Meier and Cox proportional hazards models were employed to assess mortality risk associated with co-infections up to 6 months of age.

Main Results:

  • By 6 weeks, 79% of infants were CMV-positive, with 11% having congenital CMV and 42% having postnatal CMV.
  • By 6 months, postnatal CMV infection showed no significant increase in mortality (aHR 1.1; 95% CI 0.6, 2.2).
  • By 6 weeks, 13% of infants had EBV co-infection, with 2% congenital and 7% postnatal; neither was associated with increased mortality by 6 months (aHR 0.8; 95% CI 0.3, 2.3).

Conclusions:

  • The majority of HIV-infected infants acquired CMV by 6 weeks, and EBV co-infection occurred earlier than anticipated.
  • A high prevalence of congenital CMV and the identification of congenital EBV infection (newly reported in Africa/HIV context) were observed.
  • Neither CMV nor EBV co-infection demonstrated a statistically significant association with increased mortality in HIV-infected infants within the study period.
Abstract

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