Role of antenatal plasma cytomegalovirus DNA levels on pregnancy outcome and HIV-1 vertical transmission among mothers in the University of Zimbabwe birth cohort study (UZBCS)

• Published in: Virology journal Vol. 18; no. 1; p. 30
• Main Authors: Duri, Kerina, Chimhuya, Simbarashe, Gomo, Exnevia, Munjoma, Privilege Tendai, Chandiwana, Panashe, Yindom, Louis Marie, Mhandire, Kudakwashe, Ziruma, Asaph, Mtapuri-Zinyowera, Sekesai, Mazengera, Lovemore Ronald, Misselwitz, Benjamin, Gumbo, Felicity Zvanyadza, Jordi, Sebastian, Rowland-Jones, Sarah
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.01.2021; BioMed Central; BMC
• Subjects: Adolescent; Adult; Age; Antenatal CMV-DNAemia; Babies; Birth outcomes; Birth weight; Breast feeding; Breastfeeding & lactation; Care and treatment; Case-Control Studies; CD4 antigen; Children; Cohort analysis; Cohort Studies; Complications and side effects; Congenital diseases; Cytomegalovirus; Cytomegalovirus - genetics; Cytomegalovirus infections; Cytomegalovirus Infections - blood; Deoxyribonucleic acid; Developing countries; Disease; Disease transmission; DNA; DNA, Viral - blood; Female; Gestational age; Health aspects; HIV; HIV infection in children; HIV Infections - transmission; HIV-1 - genetics; HIV-1 vertical transmission; HIV-1-RNA load; Human immunodeficiency virus; Humans; Industrialized nations; Infant; Infant health; Infant, Newborn; Infants; Infections; Infectious Disease Transmission, Vertical - prevention & control; LDCs; Maternal-fetal exchange; Mortality; Mothers; Multivariate analysis; Plasma; Polymerase chain reaction; Postpartum; Pregnancy; Pregnancy Complications, Infectious - virology; Pregnancy Outcome; Premature birth; Prenatal Diagnosis - statistics & numerical data; Ribonucleic acid; Risk factors; RNA; RNA-directed DNA polymerase; Viruses; Womens health; Young Adult; Zimbabwe; Zimbabwe; Germany; HIV-1-RNA load; Birth outcomes; HIV-1 vertical transmission; Antenatal CMV-DNAemia; Infant health
• ISSN: 1743-422X; 1743-422X
• DOI: 10.1186/s12985-021-01494-3

Despite being a leading infectious cause of childhood disability globally, testing for cytomegalovirus (CMV) infections in pregnancy is generally not done in Sub-Sahara Africa (SSA), where breastfeeding practice is almost universal. Whilst CMV and human immunodeficiency virus (HIV) are both endemic in SSA, the relationship between antenatal plasma CMV-DNA, HIV-1-RNA levels and HIV-1-mother to child transmission (MTCT) including pregnancy outcomes remains poorly described. Pregnant women at least 20 weeks' gestational age at enrolment were recruited from relatively poor high-density suburbs in Harare, Zimbabwe. Mother-infant dyads were followed up until 6 months postpartum. In a case-control study design, we tested antenatal plasma CMV-DNA levels in all 11 HIV-1 transmitting mothers, as well as randomly selected HIV-infected but non-transmitting mothers and HIV-uninfected controls. CMV-DNA was detected and quantified using polymerase chain reaction (PCR) technique. Antenatal plasma HIV-1-RNA load was quantified by reverse transcriptase PCR. Infants' HIV-1 infection was detected using qualitative proviral DNA-PCR. Predictive value of antenatal plasma CMV-DNAemia (CMV-DNA of > 50 copies/mL) for HIV-1-MTCT was analyzed in univariate and multivariate regression analyses. Associations of CMV-DNAemia with HIV-1-RNA levels and pregnancy outcomes were also explored. CMV-DNAemia data were available for 11 HIV-1 transmitting mothers, 120 HIV-infected but non-transmitting controls and 46 HIV-uninfected mothers. In a multivariate logistic regression model, we found a significant association between CMV-DNAemia of > 50 copies/mL and HIV-1 vertical transmission (p = 0.035). There was no difference in frequencies of detectable CMV-DNAemia between HIV-infected and -uninfected pregnant women (p = 0.841). However, CMV-DNA levels were higher in immunosuppressed HIV-infected pregnant women, CD4 < 200 cells/µL (p = 0.018). Non-significant associations of more preterm births (< 37 weeks, p = 0.063), and generally lower birth weights (< 2500 g, p = 0.450) were observed in infants born of HIV-infected mothers with CMV-DNAemia. Furthermore, in a multivariate analysis of HIV-infected but non-transmitting mothers, CMV-DNAemia of > 50 copies/mL correlated significantly with antenatal plasma HIV-1-RNA load (p = 0.002). Antenatal plasma CMV-DNA of > 50 copies/mL may be an independent risk factor for HIV-1-MTCT and higher plasma HIV-1-RNA load, raising the possibility that controlling antenatal CMV-DNAemia might improve infant health outcomes. Further studies with larger sample sizes are warranted to confirm our findings.