Pregnant women co-infected with HIV and Zika: Outcomes and birth defects in infants according to maternal symptomatology

• Published in: PloS one Vol. 13; no. 7; p. e0200168
• Main Authors: João, Esaú C, Ferreira, Jr, Orlando da C, Gouvêa, Maria Isabel, Teixeira, Maria de Lourdes B, Tanuri, Amilcar, Higa, Luiza M, Costa, Deise A, Mohana-Borges, Ronaldo, Arruda, Mônica B, Matos, Haroldo J, Cruz, Maria Leticia, Mendes-Silva, Wallace, Read, Jennifer S
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06.07.2018; Public Library of Science (PLoS)
• Subjects: Abnormalities; Analysis; Biology and life sciences; Birth defects; Central nervous system; Chikungunya fever; Chikungunya virus; Congenital defects; Congenital diseases; Dengue; Dengue fever; Diagnosis; Epidemics; Family medical history; Gestation; Guillain-Barre syndrome; Health aspects; HIV; Hospitals; Human immunodeficiency virus; Immunoglobulin G; Immunology; Infants; Infection; Infections; Infectious diseases; Internet; Laboratories; Laboratory tests; Medicine and Health Sciences; Microcephaly; Outbreaks; People and Places; Poisson density functions; Polymerase chain reaction; Pregnancy; Pregnant women; Regression analysis; Risk analysis; Risk factors; Statistical analysis; Statistical significance; Statistical tests; Vector-borne diseases; Viral diseases; Viruses; Womens health; Zika virus; Brazil; Rio de Janeiro Brazil; San Francisco California; California; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0200168

Zika virus (ZIKV) was first isolated in Uganda in 1947. In Brazil, the first reported case of ZIKV infection was in May 2015. Additionally, dengue (DENV) is endemic and there has been a recent outbreak of chikungunya (CHIKV). Since the clinical manifestations of different arboviral infections (AI) can be similar, definitive diagnosis requires laboratory testing. To determine the prevalence of ZIKV, DENV, and CHIKV infections in a Brazilian cohort of HIV-infected pregnant women, to assess clinical/immunological characteristics and pregnancy outcomes of women with evidence of recent AI. Laboratory diagnosis of ZIKV, DENV and CHIKV infections utilized serological assays, RT-PCR and PRNT. The tests were performed at the first visit, 34-36 weeks of gestation and at any time if a woman had symptoms suggestive of AI. Mann-Whitney tests were used for comparison of medians, Chi-square or Fisher's to compare proportions; p< 0.05 was considered statistically significant. Poisson regression was used to analyze risk factors for central nervous system (CNS) malformations in the infant according to maternal symptomatology. Of 219 HIV-infected pregnant women enrolled, 92% were DENV IgG+; 47(22%) had laboratory evidence of recent AI. Of these, 34 (72%) were ZIKV+, nine (19%) CHIKV+, and two (4%) DENV+. Symptoms consistent with AI were observed in 23 (10%) women, of whom 10 (43%) were ZIKV+, eight (35%) CHIKV+. No CNS abnormalities were observed among infants of DENV+ or CHIKV+ women; four infants with CNS abnormalities were born to ZIKV+ women (three symptomatic). Infants born to ZIKV+ women had a higher risk of CNS malformations if the mother was symptomatic (RR = 7.20), albeit not statistically significant (p = 0.066). Among HIV-infected pregnant women with laboratory evidence of a recent AI, 72% were ZIKV-infected. In this cohort, CNS malformations occurred among infants born to both symptomatic and asymptomatic pregnant women with Zika infection.