Congenital CMV infection in HIV-infected women on HAART

Background – The introduction of antiretroviral therapy (ART/HAART) has modified both the natural history of HIV disease and the epidemiology of CMV disease in HIV patients by lowering the rate of CMV reactivation. Anti retroviral therapy is recommended in HIV infected women in order to reduce the risk of vertical transmission of HIV. Objective – To verify whether ART/HAART can have some preventive effect also on the vertical transmission of CMV Design – Retrospective survey of congenital CMV infection in a cohort of HIV infected pregnant women on ART/HAART . Materials and methods – We examined 303 consecutive children born in the years 2000-2005. The mothers received lamivudine plus zidovudine since week 22 (13-38) of pregnancy; from 2003 a protease inhibitor was added to the treatment; their CMV serological status was assessed at first visit, HIV viral load and CD4/CD8 counts were measured at delivery. All newborns were screened for congenital CMV infection by means of viral isolation and/or CMV PCR on saliva samples collected in the first 3 days of life. Urine and PBL of infected babies were examined in the following days and at clinical follow-up visits. Results – Vertical transmission of CMV occurred in 9 cases (2.97%), HIV was transmitted in two other babies only (0.6%). Four of the CMV infected children were premature, one of them was symptomatic at birth, one developed a monolateral hearing loss at age 4. None of the term babies was symptomatic at birth nor has developed any sequela so far. Only the mother of the symptomatic girl had a positive IgM test, all the other transmitting mothers were IgG+/IgM- in pregnancy. Conclusions – 1)Congenital CMV rate is about 10 times higher than in the open Italian population (0.2%), but lower than the one (5.7%) found in a previous Italian study on babies born to HIV infected mothers; 2) The lower rate of transmission might be due to the reduction of CMV reactivation caused by ART/HAART.