Human cytomegalovirus (HHV5) reactivation during lactation

A globally prevalent human cytomegalovirus (HCMV), capable of establishing a lifelong infection in the host, exists in a latent state and can reactivate. Viral transmission can occur through contact with the bodily fluids of infected individuals, such as saliva, semen, urine, and breast milk. The infection is usually asymptomatic. However, immunocompromised individuals are more prone to experience severe complications, including pneumonia, organ damage, and retinitis. Because of high levels of HCMV in breast milk, breastfeeding by seropositive mothers may lead to viral transmission, which is most hazardous in low-birth-weight and very preterm infants. During infection, thrombocytopenia and inflammation of the lungs, liver, retina, and meninges may occur. To date, risk mitigation strategies have included pasteurization of breast milk. HCMV latency is defined as the presence of the viral genome in the infected cell without the production of infectious viral particles. This state is regulated by viral proteins, such as LUNA, UL138, and US28, as well as viral miRNAs, which silence transcription of immediate-early genes. The virus also avoids eliciting an immune response by suppressing the MHC class II presentation, utilizing viral IL-10 homologs, and impairing T-cell recognition. The reactivation of HCMV can be triggered by cellular differentiation or by the release of inflammatory cytokines, leading to the re-expression of viral IE genes and subsequent viral replication. This review summarizes the current knowledge of HCMV's molecular biology and pathogenesis, emphasizing the interplay between viral and host factors during latency and reactivation. It also highlights the importance of milk-mediated infection and its implications for neonatal health.