The following is a summary of “Maternal and infant cytomegalovirus detection among women living with HIV,” published in the FEBRUARY 2023 issue of Obstetrics and Gynecology by McClymont E, et al.

For a study, researchers sought to investigate the association between CMV replication in blood collected longitudinally from pregnant women living with HIV (WLWH) and parameters of HIV infection and infant congenital CMV infection. 

It was a multi-center prospective cohort study conducted in Canada, where data and specimens were collected at each trimester, delivery, and 4-16 weeks postpartum from pregnant WLWH. Maternal CMV viral load (VL) was measured using qPCR, and congenital infection was determined through CMV qPCR of infant oral samples (0-3 days of life). In addition, the researchers explored the associations between CMV viremia, antiretroviral therapy (ART), baseline and nadir CD4 count, and HIV VL using logistic regression models.

The study included 298 pregnant WLWH, of which 216 were CMV seropositive. At the first pregnancy visit, their median CD4 count was 531 (IQR: 390-723) cells/mm3, and 114 (53%) had undetectable HIV VL. Out of 932 blood specimens collected, 34 obtained from 28 (13%) women were CMV qPCR positive, and neither age nor HIV parameters (baseline/nadir CD4, VL, timing of ART initiation) were found to be associated with CMV viremia. Interestingly, maternal CMV detection was often discordant between blood and oral specimens. Among 181 infants sampled at 0-3 days, only one (0.6%) was found to have congenital CMV infection (466,000 IU/ul), and the mother of this infant was viremic. Despite the fact that no infant was breastfed, this rate rose to 11 (5.5%) at 4-16 weeks of age.

In contrast to previous rates of ~0.5% CMV seropositivity in pregnant women without HIV, 13% of CMV seropositive WLWH exhibited detectable CMV viremia during pregnancy. However, the prevalence of cCMV at birth did not seem to be increased.

Reference: ajog.org/article/S0002-9378(22)00992-9/fulltext