In the Journals

Mothers with CMV more likely to transmit HIV to infants

Among women with HIV who did not receive ART during pregnancy, those with evidence of cytomegalovirus, or CMV, in their urine at the time of labor and delivery were five times more likely to transmit HIV to their infants than women without CMV, according to recent findings.

In addition, Karin Nielsen-Saines, MD, MPH, professor of clinical pediatrics in the division of infectious diseases at the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues found that these women were nearly 30 times more likely to transmit CMV to their infants.

Photo of Karin Nielsen-Saines
Karin Nielsen-Saines

“The findings were surprising because prior studies in healthy pregnant women have not shown an association between CMV detection in urine, or even cervical secretions, and congenital CMV infection,” Nielsen said in a press release.

The researchers examined data from a subset of participants enrolled in the perinatal NICHD HPTN 040 study — a phase 3 trial evaluating the efficacy of three antiretroviral prophylaxis regimens in infants born to mothers with HIV who did not receive ART during pregnancy. The recent analysis included data from 260 women in the Americas (85.4%) and South Africa (14.6%) and their infants.

Urine samples of 9.2% of women were positive for CMV at the time of labor and delivery. Among potential risk factors for maternal CMV, including mean HIV viral load and CD4 cell count, only age was associated with CMV viruria (P = .02). The virus was significantly more common at the time of delivery among younger women aged 13 to 24 years (OR = 6.2; 95% CI, 1.4-28.3) and those aged 25 to 29 years (OR = 5.4; 95% CI, 1.1-26).

Infants born to mothers with CMV had significantly higher rates of perinatal HIV (29.2% vs. 8.1%; P = .002) and CMV (20.8% vs. 2.1%; P = .0001) than infants born to mothers without CMV. The researchers estimated that women with CMV were nearly five times more likely to transmit HIV to their infants (OR = 4.7; 95% CI, 1.7-12.8). After adjusting for mode of delivery, maternal gonococcal infection and maternal HIV viral load, they found that the odds of transmitting CMV were 29.7 (95% CI, 5.4-164.2) times higher among mothers with CMV than those without CMV. Furthermore, additional adjusted analyses showed that women with gonococcal infection were nearly 20 times more likely to have an infant with congenital CMV (aOR = 19.5; 95% CI, 2.5-151.3). According to the researchers, this finding corresponds with existing evidence from other studies.

“Our results appear to underscore the necessity of controlling maternal HIV infection during pregnancy through use of antiretrovirals to prevent both HIV and CMV transmission to neonates,” they concluded. “Additional studies are needed to evaluate the role of both CMV urinary and genital shedding during pregnancy and the potential role this may play in the risk of in utero transmission of both HIV and CMV.” – by Stephanie Viguers

Disclosure: The researchers report no relevant financial disclosures.

*Photo credit: UCLA HealthInfographic demonstrating risk for mother-to-child HIV transmission

Among women with HIV who did not receive ART during pregnancy, those with evidence of cytomegalovirus, or CMV, in their urine at the time of labor and delivery were five times more likely to transmit HIV to their infants than women without CMV, according to recent findings.

In addition, Karin Nielsen-Saines, MD, MPH, professor of clinical pediatrics in the division of infectious diseases at the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues found that these women were nearly 30 times more likely to transmit CMV to their infants.

Photo of Karin Nielsen-Saines
Karin Nielsen-Saines

“The findings were surprising because prior studies in healthy pregnant women have not shown an association between CMV detection in urine, or even cervical secretions, and congenital CMV infection,” Nielsen said in a press release.

The researchers examined data from a subset of participants enrolled in the perinatal NICHD HPTN 040 study — a phase 3 trial evaluating the efficacy of three antiretroviral prophylaxis regimens in infants born to mothers with HIV who did not receive ART during pregnancy. The recent analysis included data from 260 women in the Americas (85.4%) and South Africa (14.6%) and their infants.

Urine samples of 9.2% of women were positive for CMV at the time of labor and delivery. Among potential risk factors for maternal CMV, including mean HIV viral load and CD4 cell count, only age was associated with CMV viruria (P = .02). The virus was significantly more common at the time of delivery among younger women aged 13 to 24 years (OR = 6.2; 95% CI, 1.4-28.3) and those aged 25 to 29 years (OR = 5.4; 95% CI, 1.1-26).

Infants born to mothers with CMV had significantly higher rates of perinatal HIV (29.2% vs. 8.1%; P = .002) and CMV (20.8% vs. 2.1%; P = .0001) than infants born to mothers without CMV. The researchers estimated that women with CMV were nearly five times more likely to transmit HIV to their infants (OR = 4.7; 95% CI, 1.7-12.8). After adjusting for mode of delivery, maternal gonococcal infection and maternal HIV viral load, they found that the odds of transmitting CMV were 29.7 (95% CI, 5.4-164.2) times higher among mothers with CMV than those without CMV. Furthermore, additional adjusted analyses showed that women with gonococcal infection were nearly 20 times more likely to have an infant with congenital CMV (aOR = 19.5; 95% CI, 2.5-151.3). According to the researchers, this finding corresponds with existing evidence from other studies.

“Our results appear to underscore the necessity of controlling maternal HIV infection during pregnancy through use of antiretrovirals to prevent both HIV and CMV transmission to neonates,” they concluded. “Additional studies are needed to evaluate the role of both CMV urinary and genital shedding during pregnancy and the potential role this may play in the risk of in utero transmission of both HIV and CMV.” – by Stephanie Viguers

Disclosure: The researchers report no relevant financial disclosures.

*Photo credit: UCLA HealthInfographic demonstrating risk for mother-to-child HIV transmission