Postnatal CMV acquisition risk is not increased among children who are HIV-exposed, uninfected versus HIV-unexposed in the setting of optimized maternal ART
- 1University of Washington
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.
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BibTeX
@misc{begnel2026postnatal,
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}},
author = {E. R. Begnel and M.-S. Kang Dufour and K. Govender and J. Hu and E. McClymont and E. Ojee and P. Owiti and J. Adhiambo and E. Mabele and I. Boucoiran and F. Kakkar and B. H. Chohan and D. A. Lehman and J. Kinuthia and D. Wamalwa and S. Gantt and J. Slyker},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.27.26365941},
url = {https://www.medrxiv.org/content/10.64898/2026.10.27.26365941v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Postnatal CMV acquisition risk is not increased among children who are HIV-exposed, uninfected versus HIV-unexposed in the setting of optimized maternal ART
AU - E. R. Begnel
AU - M.-S. Kang Dufour
AU - K. Govender
AU - J. Hu
AU - E. McClymont
AU - E. Ojee
AU - P. Owiti
AU - J. Adhiambo
AU - E. Mabele
AU - I. Boucoiran
AU - F. Kakkar
AU - B. H. Chohan
AU - D. A. Lehman
AU - J. Kinuthia
AU - D. Wamalwa
AU - S. Gantt
AU - J. Slyker
PY - 2026
DA - 2026/10/27
PB - medRxiv
DO - 10.64898/2026.10.27.26365941
UR - https://www.medrxiv.org/content/10.64898/2026.10.27.26365941v1
AB - 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.
ER -