{
  "abstract": "Historically, children who are HIV-exposed, uninfected (CHEU) had higher incidence and earlier postnatal acquisition of cytomegalovirus (CMV) than children who are HIV-unexposed. We assessed whether this difference persists in the current era of universal antiretroviral therapy (ART). Women without HIV and women living with HIV (WLHIV) on ART for [≥]6 months were recruited in pregnancy in Nairobi, Kenya and followed weekly with their infant for 12 months postpartum; 89% of WLHIV initiated ART pre-conception. Log10-CMV DNA levels were measured in infant urine, oral swabs, and plasma, and in maternal breast milk, oral swabs, and vaginal swabs. Infant plasma collected at age [≥]12 months was tested for CMV IgG antibodies. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to compare CMV acquisition by HIV exposure and assess correlates of CMV infection. Of 65/72 (90%) infants with ascertainable CMV status and timing of acquisition (42% CHEU), 47 (72%) acquired CMV. WLHIV had higher mean CMV DNA levels than women without HIV in breast milk (4.17-log vs 3.12-log, p<0.001) and oral swabs (1.10-log vs 0.78-log, p<0.001). Though higher breast milk and oral swab CMV DNA levels were associated with increased hazard of CMV among all infants (adjusted hazard ratio [aHR]=2.80, 95% CI: 1.77-4.43 and aHR=1.35, 95% CI: 1.14-1.60), HIV exposure was not significantly associated with CMV acquisition (aHR=1.31, 95% CI: 0.71-2.42). Hazard of CMV was lower among CHEU that received cotrimoxazole prophylaxis (aHR=0.19, 95% CI: 0.074-0.47) and whose mothers received a recommended first line ART regimen postpartum (aHR=0.37, 95% CI: 0.15-0.93). Together, these findings suggest that risk of CMV infection among CHEU is modulated by level of maternal mucosal CMV shedding, maternal ART regimen, and cotrimoxazole in this setting of optimized, pre-conception ART. Breast milk remains an important source of postnatal CMV acquisition for all infants.",
  "abstract_shown": true,
  "affiliations": [
    "University of Washington"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 17,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "E. R. Begnel"
    },
    {
      "name": "M.-S. Kang Dufour"
    },
    {
      "name": "K. Govender"
    },
    {
      "name": "J. Hu"
    },
    {
      "name": "E. McClymont"
    },
    {
      "name": "E. Ojee"
    },
    {
      "name": "P. Owiti"
    },
    {
      "name": "J. Adhiambo"
    },
    {
      "name": "E. Mabele"
    },
    {
      "name": "I. Boucoiran"
    },
    {
      "name": "F. Kakkar"
    },
    {
      "name": "B. H. Chohan"
    },
    {
      "name": "D. A. Lehman"
    },
    {
      "name": "J. Kinuthia"
    },
    {
      "name": "D. Wamalwa"
    },
    {
      "name": "S. Gantt"
    },
    {
      "name": "J. Slyker"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1yyty485vpsnh.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.27.26365941",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.27.26365941v1.full",
  "id": "1yyty485vpsnh",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.27.26365941v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "hiv aids"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.27.26365941v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-27",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/1yyty485vpsnh.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:22:05Z",
      "native_id": "10.64898/2026.10.27.26365941",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.27.26365941v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:hiv aids",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Postnatal CMV acquisition risk is not increased among children who are HIV-exposed, uninfected versus HIV-unexposed in the setting of optimized maternal ART",
  "title_text": "Postnatal CMV acquisition risk is not increased among children who are HIV-exposed, uninfected versus HIV-unexposed in the setting of optimized maternal ART",
  "type": "preprint",
  "updated_at": "2026-10-31T00:20:43Z",
  "url": "https://research.draconitic.com/paper/1yyty485vpsnh",
  "venue": "medRxiv",
  "versions": []
}