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The Effect of Prenatal Highly Active Antiretroviral Therapy (HAART) on the Transmission of Congenital and Perinatal/Early Postnatal Cytomegalovirus (CMV) Among HIV-Infected and Exposed Infants.
MedLine Citation:
PMID:  22675157     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background. Before highly active antiretroviral therapy (HAART), congenital CMV rates were higher among HIV-exposed infants compared to unexposed infants. This study examines congenital and perinatal/early postnatal (P/EP) CMV rates among HIVexposed infants before and after HAART.Methods. Infants born to HIV-infected women were evaluated for congenital CMV infection (CMV+ culture in the first 3 weeks of life) and P/EP CMV (positive culture in first 6 months of life). Prenatal maternal HAART was defined as triple antiretroviral therapy (ART) with at least one non-nucleoside or protease inhibitor.Results. Among 414 infants evaluated within the first 6 months of life, 1678 CMV assessment days were completed (mean = 3 assessment days/child). Congenital CMV rates did not differ by time period, HAART use or infant HIV infection status. P/EP CMV rates were greater for birth cohort 1988-1996 (17.9%) compared to 1997-2002 (8.9%) (P < .01), infants HIV-infected vs uninfected (P < .01), and infants with no maternal ART vs those with ART (P < .01). Controlling for potential confounders, P/EP CMV was associated with no maternal ART (OR = 4.7, P < .01) and among those with no maternal ART, P/EP CMV was associated with mothers CD4 count ≤200&emsp14;cells/mm(3) (P < .01). For HIV-uninfected infants with P/EP CMV, symptoms including splenomegaly, lymphadenopathy and hepatomegaly were greater in those with no maternal HAART vs those with HAART (41% vs 6%, P < .05).Conclusions. While congenital CMV rates did not change, the post HAART era showed reduced perinatal/early postnatal CMV and occurrence of related clinical symptoms. These findings underscore the importance of prenatal HAART for all HIV-infected pregnant women.
Authors:
Toni Frederick; James Homans; Lashonda Spencer; Francoise Kramer; Alice Stek; Eva Operskalski; Andrea Kovacs
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-6
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  -     ISSN:  1537-6591     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Dept. of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California 90033.
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