In infants with HIV, coinfection with CMV may hasten disease progression

Infants coinfected with HIV and cytomegalovirus may be more likely to show signs of rapid HIV disease progression than infants with HIV who do not have cytomegalovirus, according to results presented at the 16th Annual Conference on Retroviruses and Opportunistic Infections in Montreal.

Researchers examined 63 infants who were born with HIV in Durban, South Africa. The infants were studied on day one and day 28 of life. All infants were examined monthly; HIV viral load and CD4 counts were tested at each visit.

Fifty-nine percent of infants tested positive for cytomegalovirus by 98 days of life. Infants who developed cytomegalovirus were more likely to be breastfed, though there was no difference in HIV viral load of maternal disease status between infants who did and did not develop cytomegalovirus.

Birth CD4 count was similar among infants who developed cytomegalovirus and those that did not. However, CD4 counts declined twice as rapidly in infants who developed cytomegalovirus than among those that did not (10.5% decline per month compared with 5% decline per month). Even after 12 months of ART, CD4 counts were lower among infants with cytomegalovirus (29% vs. 36%).

Morbidity and mortality were similar in both groups. However, researchers said failure to thrive was more common among infants with cytomegalovirus. – by Jay Lewis

This is an interesting finding. Co-infections have been known to impact HIV diseases, often worsening immunological parameters such as CD4 count and infectious parameters such as viral load. What is interesting in this study is that although CD4 counts were worse in CMV co-infected children, the short term morbidity and mortality were not different. Clearly a study with more patients and longer follow-up is required to understand the true impact of CMV co-infection in children with HIV. This information is helpful to know in the ongoing management of children with HIV.

Mobeen H. Rathore, MD

Director,
University of Florida Center for HIV/AIDS
Research, Education and Service (UF CARES)

For more information:

Prendergast A. #93LB. Presented at: the 16th Annual Conference on Retroviruses and Opportunistic Infections; Feb. 8-11, 2009; Montreal.