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Cytomegalovirus Viremia in HIV-1 Subtype C Positive Women at Delivery in Botswana and Adverse Birth/Infant Health Outcomes

Moraka, Natasha O., BSa; Moyo, Sikhulile, MSc, MPH, PhDa,b; Mayondi, Gloria, BSa; Leidner, Jean, MScc; Ibrahim, Maryanne, MDd; Smith, Christiana, MD, MSce; Weinberg, Adriana, MDe; Li, Shaobing, MDe; Thami, Prisca K., MSca; Kammerer, Betsy, PhDf,g; Ajibola, Gbolahan, MBBS, MPHa; Musonda, Rosemary, PhDa,b; Shapiro, Roger, MDa,b,g,h; Gaseitsiwe, Simani, PhDa,b; Lockman, Shahin, MD, MSca,b,g,i

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1, 2019 - Volume 81 - Issue 1 - p 118–124
doi: 10.1097/QAI.0000000000001982
Translational Research

Background: We evaluated the association between maternal cytomegalovirus (CMV) viremia during pregnancy and adverse birth and infant health outcomes in HIV-infected mothers and their HIV-exposed uninfected infants.

Methods: HIV-positive women and their infants were followed prospectively from pregnancy through 2 years postpartum in the “Tshipidi” study in Botswana. We analyzed the association between detectable CMV DNA in maternal blood at delivery and adverse birth outcomes (stillbirth, preterm delivery, small for gestational age, or birth defect), as well as infant hospitalization and mortality through 24 months.

Results: We measured CMV DNA in blood samples from 350 (77.1%) of 454 HIV-positive women from the Tshipidi study. The median maternal CD4 count was 422 cells/mL, and median HIV-1 RNA at entry was 3.2 log10 copies/mL. Fifty-one (14.6%) women had detectable CMV DNA. In unadjusted analyses, detectable CMV DNA was associated with higher maternal HIV-1 RNA [odds ratio (OR) 1.4, 95% confidence interval (CI): 1.1 to 1.9], presence of a birth defect (OR 9.8, 95% CI: 1.6 to 60.3), and occurrence of any adverse birth outcome (OR 2.0, 95% CI: 1.04 to 3.95). In multivariable analysis, we observed a trend toward association between detectable maternal CMV DNA and occurrence of any adverse birth outcome (adjusted OR 1.9, 95% CI: 0.96 to 3.8). Maternal CMV viremia was not associated with infant hospitalization and/or death by 24 months.

Conclusions: Approximately 1 in 6 HIV-positive women in Botswana had detectable CMV DNA in blood at delivery. The presence of maternal CMV viremia had a borderline association with adverse birth outcomes but not with 24-month morbidity or mortality in HIV-exposed uninfected children.

aResearch Laboratory, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana;

bDepartment of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA;

cGoodtables Data Consulting, Norman, OK;

dDepartment of Pediatrics, Baylor College of Medicine, Houston, TX;

ePediatric Infectious Diseases University of Colorado Denver, Denver, CO;

fDepartment of Psychiatry, Boston Children's Hospital, Boston, MA;

gHarvard Medical School, Boston, MA;

hDivision of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA; and

iDivision of Infectious Diseases, Brigham and Women's Hospital, Boston, MA.

Correspondence to: Simani Gaseitsiwe, PhD, Botswana Harvard AIDS Institute Partnership, Plot 1836 North Ring Road, Gaborone, Botswana (e-mail:

Supported by National Institute of Mental Health (RO1 MH087344). N.O.M., S.M., and S.G. were partly supported through the sub-Saharan African Network for TB/HIV Research Excellence (SANTHE), a DELTAS Africa Initiative [grant # DEL-15-006]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)'s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [grant # 107752/Z/15/Z] and the UK government. N.O.M. was supported was supported from the National Institutes of Health (NIH) Fogarty International Center (Grant # 5D43TW009610) and OAK Foundation (Grant # OUSA-12-025). Part of S.L.'s effort on this project was supported by K24 AI131928. The views expressed in this publication are those of the author(s) and not necessarily those of the funding agencies.

The authors have no funding or conflicts of interest to disclose.

Received October 17, 2018

Accepted December 27, 2018

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