Birth Prevalence of Congenital Cytomegalovirus Infection in HIV-Exposed Uninfected Children in the Era of Combination Antiretroviral Therapy

Murli U. Purswani; Jonathan S. Russell; Monika Dietrich; Kathleen Malee; Stephen A. Spector; Paige L. Williams; Toni Frederick; Sandra Burchett; Sean Redmond; Howard J. Hoffman; Peter Torre; Sonia Lee; Mabel L. Rice; Tzy Jyun Yao; Ellen Chadwick; Margaret Ann Sanders; Scott Hunter; William Shearer; Mary Paul; Chivon McMullen-Jackson; Ruth Eser-Jose; Lynnette Harris; Mahoobullah Mirza Baig; Alma Villegas; Lisa Gaye-Robinson; Jawara Dia Cooley; James Blood; Patricia Garvie; William Borkowsky; Sandra Deygoo; Jennifer Lewis; Arry Dieudonne; Linda Bettica; Juliette Johnson; Karen Surowiec; Katherine Knapp; Kim Allison; Megan Wilkins; Jamie Russell-Bell; Nicolas Rosario; Lourdes Angeli-Nieves; Vivian Olivera; Stephan Kohlhoff; Ava Dennie; Jean Kaye; Russell Van Dyke; Karen Craig; Patricia Sirois; Cecelia Hutto; Paige Hickman; Dan Marullo; Veronica Figueroa; Megan Loughran; Sharon Nichols; Elizabeth McFarland; Emily Barr; Christine Kwon; Carrie Glenny; Mobeen Rathore; Kristi Stowers; Saniyyah Mahmoudi; Nizar Maraqa; Rosita Almira; Karen Hayani; Lourdes Richardson; Renee Smith; Alina Miller; Gwendolyn Scott; Maria Mogollon; Gabriel Fernandez; Anai Cuadra; Mariam Davtyan; Jennifer Vinas; Guadalupe Morales-Avendano; Zoe M. Rodriguez; Lizmarie Torres; Nydia Scalley

doi:10.1016/j.jpeds.2019.09.025

Birth Prevalence of Congenital Cytomegalovirus Infection in HIV-Exposed Uninfected Children in the Era of Combination Antiretroviral Therapy

Murli U. Purswani, Jonathan S. Russell, Monika Dietrich, Kathleen Malee, Stephen A. Spector, Paige L. Williams, Toni Frederick, Sandra Burchett, Sean Redmond, Howard J. Hoffman, Peter Torre, Sonia Lee, Mabel L. Rice, Tzy Jyun Yao, Ellen Chadwick, Margaret Ann Sanders, Scott Hunter, William Shearer, Mary Paul, Chivon McMullen-JacksonRuth Eser-Jose, Lynnette Harris, Mahoobullah Mirza Baig, Alma Villegas, Lisa Gaye-Robinson, Jawara Dia Cooley, James Blood, Patricia Garvie, William Borkowsky, Sandra Deygoo, Jennifer Lewis, Arry Dieudonne, Linda Bettica, Juliette Johnson, Karen Surowiec, Katherine Knapp, Kim Allison, Megan Wilkins, Jamie Russell-Bell, Nicolas Rosario, Lourdes Angeli-Nieves, Vivian Olivera, Stephan Kohlhoff, Ava Dennie, Jean Kaye, Russell Van Dyke, Karen Craig, Patricia Sirois, Cecelia Hutto, Paige Hickman, Dan Marullo, Veronica Figueroa, Megan Loughran, Sharon Nichols, Elizabeth McFarland, Emily Barr, Christine Kwon, Carrie Glenny, Mobeen Rathore, Kristi Stowers, Saniyyah Mahmoudi, Nizar Maraqa, Rosita Almira, Karen Hayani, Lourdes Richardson, Renee Smith, Alina Miller, Gwendolyn Scott, Maria Mogollon, Gabriel Fernandez, Anai Cuadra, Mariam Davtyan, Jennifer Vinas, Guadalupe Morales-Avendano, Zoe M. Rodriguez, Lizmarie Torres, Nydia Scalley

New Jersey Medical School (NJMS), Pediatrics, Division of Allergy/Immunology/Infectious and Pulmonary Diseases

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

Objectives: To estimate birth prevalence of congenital cytomegalovirus (cCMV) in HIV-exposed uninfected children born in the current era of combination antiretroviral therapy and describe cCMV-related neurodevelopmental and hearing outcomes. Study design: The Surveillance Monitoring for ART Toxicities cohort study follows HIV-exposed uninfected children at 22 sites in the US and Puerto Rico. Birth cCMV prevalence was estimated in a subset of participants who had blood pellets collected within three weeks of birth and underwent ≥1 of 6 assessments evaluating cognitive and language development including an audiologic examination between 1 and 5 years of age. Detection of CMV DNA by polymerase chain reaction testing of peripheral blood mononuclear cells was used to diagnose cCMV. Proportions of suboptimal assessment scores were compared by cCMV status using Fisher exact test. Results: Mothers of 895 eligible HIV-exposed uninfected children delivered between 2007 and 2015. Most (90%) were on combination antiretroviral therapy, 88% had an HIV viral load of ≤400 copies/mL, and 93% had CD4 cell counts of ≥200 cells/μL. Eight infants were diagnosed with cCMV, yielding an estimated prevalence of 0.89% (95% CI, 0.39%-1.75%). After adjusting for a sensitivity of 70%-75% for the testing method, projected prevalence was 1.2%-1.3%. No differences were observed in cognitive, language and hearing assessments by cCMV status. Conclusions: Although birth cCMV prevalence in HIV-exposed uninfected children born to women with well-controlled HIV is trending down compared with earlier combination antiretroviral therapy-era estimates, it is above the 0.4% reported for the general US population. HIV-exposed uninfected children remain at increased risk for cCMV.

Original language	English (US)
Pages (from-to)	82-87.e2
Journal	Journal of Pediatrics
Volume	216
DOIs	https://doi.org/10.1016/j.jpeds.2019.09.025
State	Published - Jan 2020

All Science Journal Classification (ASJC) codes

Pediatrics, Perinatology, and Child Health

Keywords

HIV-exposed uninfected
cART
cCMV
congenital
cytomegalovirus
prevalence
women living with HIV

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10.1016/j.jpeds.2019.09.025

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Purswani, M. U., Russell, J. S., Dietrich, M., Malee, K., Spector, S. A., Williams, P. L., Frederick, T., Burchett, S., Redmond, S., Hoffman, H. J., Torre, P., Lee, S., Rice, M. L., Yao, T. J., Chadwick, E., Sanders, M. A., Hunter, S., Shearer, W., Paul, M., ... Scalley, N. (2020). Birth Prevalence of Congenital Cytomegalovirus Infection in HIV-Exposed Uninfected Children in the Era of Combination Antiretroviral Therapy. Journal of Pediatrics, 216, 82-87.e2. https://doi.org/10.1016/j.jpeds.2019.09.025

@article{23f9eea4c47444d39924a5d43d81674b,

title = "Birth Prevalence of Congenital Cytomegalovirus Infection in HIV-Exposed Uninfected Children in the Era of Combination Antiretroviral Therapy",

abstract = "Objectives: To estimate birth prevalence of congenital cytomegalovirus (cCMV) in HIV-exposed uninfected children born in the current era of combination antiretroviral therapy and describe cCMV-related neurodevelopmental and hearing outcomes. Study design: The Surveillance Monitoring for ART Toxicities cohort study follows HIV-exposed uninfected children at 22 sites in the US and Puerto Rico. Birth cCMV prevalence was estimated in a subset of participants who had blood pellets collected within three weeks of birth and underwent ≥1 of 6 assessments evaluating cognitive and language development including an audiologic examination between 1 and 5 years of age. Detection of CMV DNA by polymerase chain reaction testing of peripheral blood mononuclear cells was used to diagnose cCMV. Proportions of suboptimal assessment scores were compared by cCMV status using Fisher exact test. Results: Mothers of 895 eligible HIV-exposed uninfected children delivered between 2007 and 2015. Most (90%) were on combination antiretroviral therapy, 88% had an HIV viral load of ≤400 copies/mL, and 93% had CD4 cell counts of ≥200 cells/μL. Eight infants were diagnosed with cCMV, yielding an estimated prevalence of 0.89% (95% CI, 0.39%-1.75%). After adjusting for a sensitivity of 70%-75% for the testing method, projected prevalence was 1.2%-1.3%. No differences were observed in cognitive, language and hearing assessments by cCMV status. Conclusions: Although birth cCMV prevalence in HIV-exposed uninfected children born to women with well-controlled HIV is trending down compared with earlier combination antiretroviral therapy-era estimates, it is above the 0.4% reported for the general US population. HIV-exposed uninfected children remain at increased risk for cCMV.",

keywords = "HIV-exposed uninfected, cART, cCMV, congenital, cytomegalovirus, prevalence, women living with HIV",

author = "Purswani, {Murli U.} and Russell, {Jonathan S.} and Monika Dietrich and Kathleen Malee and Spector, {Stephen A.} and Williams, {Paige L.} and Toni Frederick and Sandra Burchett and Sean Redmond and Hoffman, {Howard J.} and Peter Torre and Sonia Lee and Rice, {Mabel L.} and Yao, {Tzy Jyun} and Ellen Chadwick and Sanders, {Margaret Ann} and Scott Hunter and William Shearer and Mary Paul and Chivon McMullen-Jackson and Ruth Eser-Jose and Lynnette Harris and Baig, {Mahoobullah Mirza} and Alma Villegas and Lisa Gaye-Robinson and Cooley, {Jawara Dia} and James Blood and Patricia Garvie and William Borkowsky and Sandra Deygoo and Jennifer Lewis and Arry Dieudonne and Linda Bettica and Juliette Johnson and Karen Surowiec and Katherine Knapp and Kim Allison and Megan Wilkins and Jamie Russell-Bell and Nicolas Rosario and Lourdes Angeli-Nieves and Vivian Olivera and Stephan Kohlhoff and Ava Dennie and Jean Kaye and {Van Dyke}, Russell and Karen Craig and Patricia Sirois and Cecelia Hutto and Paige Hickman and Dan Marullo and Veronica Figueroa and Megan Loughran and Sharon Nichols and Elizabeth McFarland and Emily Barr and Christine Kwon and Carrie Glenny and Mobeen Rathore and Kristi Stowers and Saniyyah Mahmoudi and Nizar Maraqa and Rosita Almira and Karen Hayani and Lourdes Richardson and Renee Smith and Alina Miller and Gwendolyn Scott and Maria Mogollon and Gabriel Fernandez and Anai Cuadra and Mariam Davtyan and Jennifer Vinas and Guadalupe Morales-Avendano and Rodriguez, {Zoe M.} and Lizmarie Torres and Nydia Scalley",

note = "Funding Information: The Pediatric HIV/AIDS Cohort Study (PHACS) was supported by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD) with co-funding from the National Institute of Dental & Craniofacial Research (NIDCR), the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Neurological Disorders and Stroke (NINDS), the National Institute on Deafness and Other Communication Disorders (NIDCD), Office of AIDS Research (OAR), the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), through cooperative agreements with the Harvard T.H. Chan School of Public Health (HD052102) and the Tulane University School of Medicine (HD052104). The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or U.S. Department of Health and Human Services. The funders did not have any role in the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit for publication. The authors declare no conflicts of interest. Funding Information: The Pediatric HIV/AIDS Cohort Study (PHACS) was supported by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD) with co-funding from the National Institute of Dental & Craniofacial Research (NIDCR) , the National Institute of Allergy and Infectious Diseases (NIAID) , the National Institute of Neurological Disorders and Stroke (NINDS) , the National Institute on Deafness and Other Communication Disorders (NIDCD) , Office of AIDS Research (OAR) , the National Institute of Mental Health (NIMH) , the National Institute on Drug Abuse (NIDA) , and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) , through cooperative agreements with the Harvard T.H. Chan School of Public Health (HD052102) and the Tulane University School of Medicine (HD052104). The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or U.S. Department of Health and Human Services. The funders did not have any role in the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit for publication. The authors declare no conflicts of interest. Publisher Copyright: {\textcopyright} 2019 Elsevier Inc.",

year = "2020",

month = jan,

doi = "10.1016/j.jpeds.2019.09.025",

language = "English (US)",

volume = "216",

pages = "82--87.e2",

journal = "Journal of Pediatrics",

issn = "0022-3476",

publisher = "Mosby Inc.",

}

Purswani, MU, Russell, JS, Dietrich, M, Malee, K, Spector, SA, Williams, PL, Frederick, T, Burchett, S, Redmond, S, Hoffman, HJ, Torre, P, Lee, S, Rice, ML, Yao, TJ, Chadwick, E, Sanders, MA, Hunter, S, Shearer, W, Paul, M, McMullen-Jackson, C, Eser-Jose, R, Harris, L, Baig, MM, Villegas, A, Gaye-Robinson, L, Cooley, JD, Blood, J, Garvie, P, Borkowsky, W, Deygoo, S, Lewis, J, Dieudonne, A, Bettica, L, Johnson, J, Surowiec, K, Knapp, K, Allison, K, Wilkins, M, Russell-Bell, J, Rosario, N, Angeli-Nieves, L, Olivera, V, Kohlhoff, S, Dennie, A, Kaye, J, Van Dyke, R, Craig, K, Sirois, P, Hutto, C, Hickman, P, Marullo, D, Figueroa, V, Loughran, M, Nichols, S, McFarland, E, Barr, E, Kwon, C, Glenny, C, Rathore, M, Stowers, K, Mahmoudi, S, Maraqa, N, Almira, R, Hayani, K, Richardson, L, Smith, R, Miller, A, Scott, G, Mogollon, M, Fernandez, G, Cuadra, A, Davtyan, M, Vinas, J, Morales-Avendano, G, Rodriguez, ZM, Torres, L & Scalley, N 2020, 'Birth Prevalence of Congenital Cytomegalovirus Infection in HIV-Exposed Uninfected Children in the Era of Combination Antiretroviral Therapy', Journal of Pediatrics, vol. 216, pp. 82-87.e2. https://doi.org/10.1016/j.jpeds.2019.09.025

TY - JOUR

T1 - Birth Prevalence of Congenital Cytomegalovirus Infection in HIV-Exposed Uninfected Children in the Era of Combination Antiretroviral Therapy

AU - Purswani, Murli U.

AU - Russell, Jonathan S.

AU - Dietrich, Monika

AU - Malee, Kathleen

AU - Spector, Stephen A.

AU - Williams, Paige L.

AU - Frederick, Toni

AU - Burchett, Sandra

AU - Redmond, Sean

AU - Hoffman, Howard J.

AU - Torre, Peter

AU - Lee, Sonia

AU - Rice, Mabel L.

AU - Yao, Tzy Jyun

AU - Chadwick, Ellen

AU - Sanders, Margaret Ann

AU - Hunter, Scott

AU - Shearer, William

AU - Paul, Mary

AU - McMullen-Jackson, Chivon

AU - Eser-Jose, Ruth

AU - Harris, Lynnette

AU - Baig, Mahoobullah Mirza

AU - Villegas, Alma

AU - Gaye-Robinson, Lisa

AU - Cooley, Jawara Dia

AU - Blood, James

AU - Garvie, Patricia

AU - Borkowsky, William

AU - Deygoo, Sandra

AU - Lewis, Jennifer

AU - Dieudonne, Arry

AU - Bettica, Linda

AU - Johnson, Juliette

AU - Surowiec, Karen

AU - Knapp, Katherine

AU - Allison, Kim

AU - Wilkins, Megan

AU - Russell-Bell, Jamie

AU - Rosario, Nicolas

AU - Angeli-Nieves, Lourdes

AU - Olivera, Vivian

AU - Kohlhoff, Stephan

AU - Dennie, Ava

AU - Kaye, Jean

AU - Van Dyke, Russell

AU - Craig, Karen

AU - Sirois, Patricia

AU - Hutto, Cecelia

AU - Hickman, Paige

AU - Marullo, Dan

AU - Figueroa, Veronica

AU - Loughran, Megan

AU - Nichols, Sharon

AU - McFarland, Elizabeth

AU - Barr, Emily

AU - Kwon, Christine

AU - Glenny, Carrie

AU - Rathore, Mobeen

AU - Stowers, Kristi

AU - Mahmoudi, Saniyyah

AU - Maraqa, Nizar

AU - Almira, Rosita

AU - Hayani, Karen

AU - Richardson, Lourdes

AU - Smith, Renee

AU - Miller, Alina

AU - Scott, Gwendolyn

AU - Mogollon, Maria

AU - Fernandez, Gabriel

AU - Cuadra, Anai

AU - Davtyan, Mariam

AU - Vinas, Jennifer

AU - Morales-Avendano, Guadalupe

AU - Rodriguez, Zoe M.

AU - Torres, Lizmarie

AU - Scalley, Nydia

N1 - Funding Information: The Pediatric HIV/AIDS Cohort Study (PHACS) was supported by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD) with co-funding from the National Institute of Dental & Craniofacial Research (NIDCR), the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Neurological Disorders and Stroke (NINDS), the National Institute on Deafness and Other Communication Disorders (NIDCD), Office of AIDS Research (OAR), the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), through cooperative agreements with the Harvard T.H. Chan School of Public Health (HD052102) and the Tulane University School of Medicine (HD052104). The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or U.S. Department of Health and Human Services. The funders did not have any role in the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit for publication. The authors declare no conflicts of interest. Funding Information: The Pediatric HIV/AIDS Cohort Study (PHACS) was supported by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD) with co-funding from the National Institute of Dental & Craniofacial Research (NIDCR) , the National Institute of Allergy and Infectious Diseases (NIAID) , the National Institute of Neurological Disorders and Stroke (NINDS) , the National Institute on Deafness and Other Communication Disorders (NIDCD) , Office of AIDS Research (OAR) , the National Institute of Mental Health (NIMH) , the National Institute on Drug Abuse (NIDA) , and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) , through cooperative agreements with the Harvard T.H. Chan School of Public Health (HD052102) and the Tulane University School of Medicine (HD052104). The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or U.S. Department of Health and Human Services. The funders did not have any role in the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit for publication. The authors declare no conflicts of interest. Publisher Copyright: © 2019 Elsevier Inc.

PY - 2020/1

Y1 - 2020/1

N2 - Objectives: To estimate birth prevalence of congenital cytomegalovirus (cCMV) in HIV-exposed uninfected children born in the current era of combination antiretroviral therapy and describe cCMV-related neurodevelopmental and hearing outcomes. Study design: The Surveillance Monitoring for ART Toxicities cohort study follows HIV-exposed uninfected children at 22 sites in the US and Puerto Rico. Birth cCMV prevalence was estimated in a subset of participants who had blood pellets collected within three weeks of birth and underwent ≥1 of 6 assessments evaluating cognitive and language development including an audiologic examination between 1 and 5 years of age. Detection of CMV DNA by polymerase chain reaction testing of peripheral blood mononuclear cells was used to diagnose cCMV. Proportions of suboptimal assessment scores were compared by cCMV status using Fisher exact test. Results: Mothers of 895 eligible HIV-exposed uninfected children delivered between 2007 and 2015. Most (90%) were on combination antiretroviral therapy, 88% had an HIV viral load of ≤400 copies/mL, and 93% had CD4 cell counts of ≥200 cells/μL. Eight infants were diagnosed with cCMV, yielding an estimated prevalence of 0.89% (95% CI, 0.39%-1.75%). After adjusting for a sensitivity of 70%-75% for the testing method, projected prevalence was 1.2%-1.3%. No differences were observed in cognitive, language and hearing assessments by cCMV status. Conclusions: Although birth cCMV prevalence in HIV-exposed uninfected children born to women with well-controlled HIV is trending down compared with earlier combination antiretroviral therapy-era estimates, it is above the 0.4% reported for the general US population. HIV-exposed uninfected children remain at increased risk for cCMV.

AB - Objectives: To estimate birth prevalence of congenital cytomegalovirus (cCMV) in HIV-exposed uninfected children born in the current era of combination antiretroviral therapy and describe cCMV-related neurodevelopmental and hearing outcomes. Study design: The Surveillance Monitoring for ART Toxicities cohort study follows HIV-exposed uninfected children at 22 sites in the US and Puerto Rico. Birth cCMV prevalence was estimated in a subset of participants who had blood pellets collected within three weeks of birth and underwent ≥1 of 6 assessments evaluating cognitive and language development including an audiologic examination between 1 and 5 years of age. Detection of CMV DNA by polymerase chain reaction testing of peripheral blood mononuclear cells was used to diagnose cCMV. Proportions of suboptimal assessment scores were compared by cCMV status using Fisher exact test. Results: Mothers of 895 eligible HIV-exposed uninfected children delivered between 2007 and 2015. Most (90%) were on combination antiretroviral therapy, 88% had an HIV viral load of ≤400 copies/mL, and 93% had CD4 cell counts of ≥200 cells/μL. Eight infants were diagnosed with cCMV, yielding an estimated prevalence of 0.89% (95% CI, 0.39%-1.75%). After adjusting for a sensitivity of 70%-75% for the testing method, projected prevalence was 1.2%-1.3%. No differences were observed in cognitive, language and hearing assessments by cCMV status. Conclusions: Although birth cCMV prevalence in HIV-exposed uninfected children born to women with well-controlled HIV is trending down compared with earlier combination antiretroviral therapy-era estimates, it is above the 0.4% reported for the general US population. HIV-exposed uninfected children remain at increased risk for cCMV.

KW - HIV-exposed uninfected

KW - cART

KW - cCMV

KW - congenital

KW - cytomegalovirus

KW - prevalence

KW - women living with HIV

UR - http://www.scopus.com/inward/record.url?scp=85074510130&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074510130&partnerID=8YFLogxK

U2 - 10.1016/j.jpeds.2019.09.025

DO - 10.1016/j.jpeds.2019.09.025

M3 - Article

C2 - 31668479

AN - SCOPUS:85074510130

SN - 0022-3476

VL - 216

SP - 82-87.e2

JO - Journal of Pediatrics

JF - Journal of Pediatrics

ER -

Birth Prevalence of Congenital Cytomegalovirus Infection in HIV-Exposed Uninfected Children in the Era of Combination Antiretroviral Therapy

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