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Kfutwah AKW, Ngoupo PAT, Sofeu CL, Ndongo FA, Guemkam G, Ndiang ST, Owona F, Penda IC, Tchendjou P, Rouzioux C, Warszawski J, Faye A, Tejiokem MC. Cytomegalovirus infection in HIV-infected versus non-infected infants and HIV disease progression in Cytomegalovirus infected versus non infected infants early treated with cART in the ANRS 12140-Pediacam study in Cameroon. BMC Infect Dis 2017; 17:224. [PMID: 28335737 PMCID: PMC5364639 DOI: 10.1186/s12879-017-2308-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 03/07/2017] [Indexed: 12/26/2022] Open
Abstract
Background The outcome of CMV/HIV co-infection in infants treated early with combined antiretroviral therapy (cART) in resource-limited settings has not been described. We aimed to estimate the prevalence and identify factors associated with early CMV infection in HIV-infected and non-infected infants included in a study in Cameroon, and to compare HIV disease progression and survival after 1 year of early cART, following infants’ CMV status. Methods HIV-infected infants followed from birth or from HIV diagnosis before 7 months old and HIV-uninfected infants born to HIV-infected or uninfected mothers were tested for CMV at a median age of 4.0 months [Interquartile range (IQR): 3.4–4.9]. Multivariable logistic regression was performed to identify factors associated with CMV infection. Early cART was offered to HIV-infected infants: mortality, immunological and virological outcomes were assessed. Results Three hundred and sixty-nine infants were tested. The proportion of infants infected with CMV at baseline was significantly higher in HIV-infected than in HIV-uninfected groups (58.9% (86/146) vs 30.0% (67/223), p < 0.001). At baseline, median CMV viral load was higher in HIV-infected (3.7 log copies/ml [IQR; 3.1–4.3]) than in HIV-uninfected infants (2.8 log copies [IQR; 2.1–3.4], p < 0.001). cART was initiated in 90% of HIV-infected infants (132/146) at a median age of 4.0 months (IQR; 3.2–5.9); in this sub-group CMV infection was independently associated with being followed from the time of HIV diagnosis rather than from birth (aOR = 3.1, 95%CI [1.2–8.0]), born to a non-single mother (aOR = 3.4[1.4–8.1]), and breastfeeding (aOR = 7.3 [2.7–19.4]). HIV-infected infants were retested after a median of 7.1 months [4.8–9.5]: CMV was undetectable in 37 of the 61 (60.7%) initially CMV-infected cases and became detectable in 8 of the 38 (21.1%) initially CMV-negative cases. After 1 year of cART, the probability of death (0.185 vs 0.203; p = 0.75), the proportion of cases with HIV RNA viral load <400 copies/ml (75.5% vs 61.5%; p = 0.17) and the mean CD4 percentage increase (10.97% vs 6.88%; p = 0.15) did not differ between CMV+ and CMV- infants. Conclusions We observed a high prevalence of CMV infection among HIV-infected infants. Early initiation of cART may have limited the negative impact of CMV even in the absence of specific anti-CMV treatment.
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Affiliation(s)
- Anfumbom K W Kfutwah
- Virology Service, Centre Pasteur of Cameroon, Member of the International Network of Pasteur Institutes, P.O. Box 31076, Yaounde, Cameroon.
| | - Paul Alain T Ngoupo
- Virology Service, Centre Pasteur of Cameroon, Member of the International Network of Pasteur Institutes, P.O. Box 31076, Yaounde, Cameroon
| | - Casimir Ledoux Sofeu
- Epidemiology and Public Health Service, Centre Pasteur of Cameroon, Member of the International Network of Pasteur Institutes, Yaounde, Cameroon
| | - Francis Ateba Ndongo
- Pediatric Day Clinic, Mother and Child Center of the Chantal Biya Foundation, Yaounde, Cameroon
| | - Georgette Guemkam
- Pediatric Day Clinic, Mother and Child Center of the Chantal Biya Foundation, Yaounde, Cameroon
| | | | - Félicité Owona
- Epidemiology and Public Health Service, Centre Pasteur of Cameroon, Member of the International Network of Pasteur Institutes, Yaounde, Cameroon
| | - Ida Calixte Penda
- Day Clinic, Laquintinie Hospital, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Patrice Tchendjou
- Epidemiology and Public Health Service, Centre Pasteur of Cameroon, Member of the International Network of Pasteur Institutes, Yaounde, Cameroon
| | - Christine Rouzioux
- Assistance Publique des Hôpitaux de Paris, Laboratoire de Virologie, Hôpital Necker, Paris, France.,Université Paris 5 René Descartes, URF de Médecine, Paris, France
| | - Josiane Warszawski
- Equipe 4 (VIH et IST)-INSERM U1018 (CESP), Le Kremlin Bicêtre, France.,Assistance Publique des Hôpitaux de Paris, Service d'Epidémiologie et de Santé Publique, Hôpital de Bicêtre, Le Kremlin Bicêtre, France.,Université de Paris Sud 11, Paris, France
| | - Albert Faye
- Assistance Publique des Hôpitaux de Paris, Pédiatrie Générale, Hôpital Robert Debré, Paris, France.,Université Paris 7 Denis Diderot, Paris Sorbonne Cité, Paris, France.,INSERM UMR 1123, ECEVE, Paris, France
| | - Mathurin Cyrille Tejiokem
- Epidemiology and Public Health Service, Centre Pasteur of Cameroon, Member of the International Network of Pasteur Institutes, Yaounde, Cameroon. .,Equipe 4 (VIH et IST)-INSERM U1018 (CESP), Le Kremlin Bicêtre, France. .,, P.O. Box 1274, Yaounde, Cameroon.
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Sofeu CL, Warszawski J, Ateba Ndongo F, Penda IC, Tetang Ndiang S, Guemkam G, Makwet N, Owona F, Kfutwah A, Tchendjou P, Texier G, Tchuente M, Faye A, Tejiokem MC. Low birth weight in perinatally HIV-exposed uninfected infants: observations in urban settings in Cameroon. PLoS One 2014; 9:e93554. [PMID: 24705410 PMCID: PMC3976419 DOI: 10.1371/journal.pone.0093554] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 03/05/2014] [Indexed: 11/19/2022] Open
Abstract
Background The consequences of maternal HIV infection for fetal growth are controversial. Here, we estimated the frequency of small for gestational age and gender (SGAG) among neonates born to HIV-infected or uninfected mothers and assessed the contribution, if any, of maternal HIV to the risk of SGAG. Methods The data used were obtained from the ANRS-Pediacam cohort in Cameroon. Pairs of newborns, one to a HIV-infected mother and the other to an uninfected mother, were identified during the first week of life, and matched on gender and recruitment site from 2007–2010. SGAG was defined in line with international recommendations as a birth weight Z-score adjusted for gestational age at delivery and gender more than two standard deviations below the mean (−2SD). Considering the matched design, logistic regression modeling was adjusted on site and gender to explore the effect of perinatal HIV exposure on SGAG. Results Among the 4104 mother-infant pairs originally enrolled, no data on birth weight and/or gestational age were available for 108; also, 259 were twins and were excluded. Of the remaining 3737 mother-infant pairs, the frequency of SGAG was 5.3% (95%CI: 4.6–6.0), and was significantly higher among HIV-infected infants (22.4% vs. 6.3%; p<.001) and lower among HIV-unexposed uninfected infants (3.5% vs. 6.3%; p<.001) than among HIV-exposed uninfected infants. Similarly, SGAG was significantly more frequent among HIV-infected infants (aOR: 4.1; 2.0–8.1) and less frequent among HIV-unexposed uninfected infants (aOR: 0.5; 0.4–0.8) than among HIV-exposed uninfected infants. Primiparity (aOR: 1.9; 1.3–2.7) and the presence of any disease during pregnancy (aOR: 1.4; 1.0–2.0) were identified as other contributors to SGAG. Conclusion Maternal HIV infection was independently associated with SGAG for HIV-exposed uninfected infants. This provides further evidence of the need for adapted monitoring of pregnancy in HIV-infected women, especially if they are symptomatic, to minimize additional risk factors for SGAG.
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Affiliation(s)
- Casimir Ledoux Sofeu
- Service d’Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun
- Université de Yaoundé I, IRD UMI 209 UMMISCO, Yaoundé, Cameroun
- Laboratoire International en Recherche Informatique et Mathématiques Appliquées, Equipe Idasco, Yaoundé, Cameroun
| | - Josiane Warszawski
- Equipe 4 (VIH et IST) - INSERM U1018 (CESP), Le Kremlin Bicêtre, France
- Assistance Publique des Hôpitaux de Paris, Service d’Epidémiologie et de Santé Publique, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- Université de Paris Sud 11, Paris, France
| | | | - Ida Calixte Penda
- Hôpital de Jour, Hôpital Laquintinie, Douala, Cameroun
- Faculté de Médecine et des Sciences Pharmaceutiques, Université de Douala, Douala, Cameroun
| | | | - Georgette Guemkam
- Centre Mère et Enfant de la Fondation Chantal Biya, Yaoundé, Cameroun
- Maternité Principale, Hôpital Central, Yaoundé, Cameroun
| | | | - Félicité Owona
- Service d’Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun
| | - Anfumbom Kfutwah
- Service de Virologie, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun
| | - Patrice Tchendjou
- Service d’Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun
| | - Gaëtan Texier
- Service d’Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun
- SESSTIM (UMR 912), Université Aix-Marseille, Marseille, France
| | - Maurice Tchuente
- Université de Yaoundé I, IRD UMI 209 UMMISCO, Yaoundé, Cameroun
- Laboratoire International en Recherche Informatique et Mathématiques Appliquées, Equipe Idasco, Yaoundé, Cameroun
| | - Albert Faye
- Assistance Publique des Hôpitaux de Paris, Pédiatrie Générale, Hôpital Robert Debré, Paris, France
- Université Paris 7 Denis Diderot, Paris Sorbonne Cité, Paris, France
| | - Mathurin Cyrille Tejiokem
- Service d’Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaoundé, Cameroun
- Equipe 4 (VIH et IST) - INSERM U1018 (CESP), Le Kremlin Bicêtre, France
- * E-mail:
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