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AIDS ; 31(13): 1809-1818, 2017 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-28609400

RESUMO

OBJECTIVE: Factors associated with poor health in HIV-exposed-uninfected (HEU) infants are poorly defined. We describe the prevalence and correlates of cytomegalovirus (CMV) viraemia in HEU and HIV-unexposed-uninfected (HUU) infants, and quantify associations with anthropometric, haematological, and immunological outcomes. DESIGN: Cross-sectional, including HEU and HUU infants from rural coastal Kenya. METHODS: Infants aged 2-8 months were studied. The primary outcome was CMV viraemia and viral load, determined by quantitative PCR. Correlates were tested by logistic and linear regression; coefficients were used to describe associations between CMV viraemia and clinical/immunological parameters. RESULTS: In total, 42 of 65 (64.6%) infants had CMV viraemia [median viral load, 3.0 (interquartile ranges: 2.7-3.5) log10 IU/ml]. Compared to community controls, HEU infants had six-fold increased odds of being viraemic (adjusted odds ratio 5.95 [95% confidence interval: 1.82-19.36], P = 0.003). Age, but not HEU/HUU status, was a strong correlate of CMV viral load (coefficient = -0.15, P = 0.009). CMV viral load associated negatively with weight-for-age (WAZ) Z-score (coefficient =  -1.06, P = 0.008) and head circumference-for-age Z-score (coefficient =  -1.47, P = 0.012) and positively with CD8 T-cell coexpression of CD38/human leucocyte antigen DR (coefficient = 15.05, P = 0.003). CONCLUSION: The odds of having CMV viraemia was six-fold greater in HEU than HUU infants when adjusted for age. CMV viral load was associated with adverse growth and heightened CD8 T-cell immune activation. Longitudinal assessments of the clinical effects of primary CMV infection and associated immunomodulation in early life in HEU and HUU populations are warranted.


Assuntos
Infecções por Citomegalovirus/complicações , Deficiências do Desenvolvimento/epidemiologia , Infecções por HIV/imunologia , Ativação Linfocitária , Exposição Materna , Linfócitos T/imunologia , Viremia/complicações , Adulto , Pré-Escolar , Estudos Transversais , Infecções por Citomegalovirus/epidemiologia , Feminino , Humanos , Lactente , Quênia/epidemiologia , Masculino , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , População Rural , Carga Viral , Viremia/epidemiologia
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