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Maternal highly active antiretroviral therapy reduces vertical CMV transmission but not maternal breast milk CMV levels

Slyker, JA, Richardson, B, Chung, MH, Atkinson, C, Ásbjörnsdóttir, KH, Lehman, DA, Boeckh, M, Emery, Vincent, Kiarie, J and Grace, J-S (2016) Maternal highly active antiretroviral therapy reduces vertical CMV transmission but not maternal breast milk CMV levels AIDS Research and Human Retroviruses.

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Abstract

Objective: To evaluate the impact of highly active antiretroviral therapy (HAART) on CMV transmission and breast milk level in the context of maternal HIV. Design: Specimens from a randomized trial conducted in Nairobi, Kenya between 2003–2005 were used to compare CMV transmission and breast milk levels between mother-infant pairs randomized to HAART versus short-course antenatal zidovudine plus single-dose nevirapine (ZDV/sdNVP) for prevention of mother-to-child HIV transmission (PMTCT). Methods: Fifty-one antiretroviral-naïve women ≤32 weeks gestation, and CD4 between 200–500 cells/mm3 were randomized at 34 weeks to begin either antenatal ZDV/sdNVP, or HAART through 6 months postpartum. Mean breast milk CMV levels and transmission were compared between arms. Results: Age, sociodemographics, CD4%, and HIV plasma RNA viral load were similar between arms at baseline. CMV viral loads were measured from 243 infant plasma and 185 breast milk specimens during the first year postpartum. The probability of infant CMV infection at 12 months was 19% lower in the HAART arm compared to ZDV/sdNVP (75% vs. 94%, p = .04). All women had CMV detected in breast milk, with 72%, 98%, and 97% testing positive during the first, second, and third weeks postpartum, respectively. There was a trend for early higher mean breast milk CMV level in the HAART arm at 1 week (p = .08), and there was significantly slower decline in breast milk CMV levels (area under the curve, p = .01). Conclusions: HAART started during the third trimester may decrease infant CMV infections, by mechanisms independent of breast milk CMV levels. Clinical trials registration: NCT00167674.

Item Type: Article
Subjects : Microbial and Cellular Sciences
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
NameEmailORCID
Slyker, JAUNSPECIFIEDUNSPECIFIED
Richardson, BUNSPECIFIEDUNSPECIFIED
Chung, MHUNSPECIFIEDUNSPECIFIED
Atkinson, CUNSPECIFIEDUNSPECIFIED
Ásbjörnsdóttir, KHUNSPECIFIEDUNSPECIFIED
Lehman, DAUNSPECIFIEDUNSPECIFIED
Boeckh, MUNSPECIFIEDUNSPECIFIED
Emery, Vincentv.emery@surrey.ac.ukUNSPECIFIED
Kiarie, JUNSPECIFIEDUNSPECIFIED
Grace, J-SUNSPECIFIEDUNSPECIFIED
Date : 6 December 2016
Identification Number : 10.1089/aid.2016.0121
Copyright Disclaimer : Final publication is available from Mary Ann Liebert, Inc., publishers http://dx.doi.org/10.1089/aid.2016.0121
Depositing User : Symplectic Elements
Date Deposited : 22 Feb 2017 18:35
Last Modified : 12 Sep 2017 17:56
URI: http://epubs.surrey.ac.uk/id/eprint/813611

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