Acute cytomegalovirus infection in Kenyan HIV-infected infants

Slyker JA, Lohman-Payne BL, John-Stewart GC, Maleche-Obimbo E, Emery S, Richardson B, Dong T, Iversena AKN, Mbori-Ngacha DA, Overbaugh J, Rowland-Jones SL. "Acute cytomegalovirus infection in Kenyan HIV-infected infants.". 2009.


Objective: Cytomegalovirus (CMV) coinfection may influence HIV-1 disease progression
during infancy. Our aim was to describe the incidence of CMV infection
and the kinetics of viral replication in Kenyan HIV-infected and HIV-exposed uninfected
Methods: HIV-1 and CMV plasma viral loads were serially measured in 20 HIVexposed
uninfected and 44 HIV-infected infants born to HIV-infected mothers.
HIV-infected children were studied for the first 2 years of life, and HIV-exposed
uninfected infants were studied for 1 year.
Results: CMVDNAwas detected frequently during the firstmonths of life; by 3months of
age,CMVDNAwasdetectedin90%ofHIV-exposeduninfectedinfantsand93%of infants
whohadacquiredHIV-1inutero.CMVviral loadswerehighest inthe1–3monthsfollowing
the first detection of virus and declined rapidly thereafter. CMV peak viral loads were
significantlyhigher in theHIV-infectedinfantscomparedwith theHIV-exposeduninfected
infants (mean3.2versus2.7 log10CMVDNAcopies/ml, respectively,P¼0.03).Thedetection
of CMV DNA persisted to 7–9 months post-CMV infection in both the HIV-exposed
uninfected (8/17, 47%) and HIV-infected (13/18, 72%, P¼0.2) children. Among HIVinfected
children, CMV DNA was detected in three of the seven (43%) surviving infants
tested between 19 and 21 months post-CMV infection. Finally, a strong correlation was
found between peak CMV and HIV-1 viral loads (r¼0.40, P¼0.008).
Conclusion: Acute CMV coinfection is common in HIV-infected Kenyan infants. HIV-1
infection was associated with impaired containment of CMV replication.


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