Congenital cytomegalovirus and associations with maternal HIV serostatus and child health outcomes in Uganda

Abstract Introduction Cytomegalovirus (CMV) is the most common congenital infection globally, and the leading cause of non-genetic hearing loss and neurodevelopmental disability. The burden is highest in low- and middle-income countries where HIV is also highly prevalent. Women living with HIV have a higher prevalence of CMV and are more likely to transmit CMV to their infants. Despite this, congenital CMV (cCMV) and newborn hearing screening are not routinely available in sub-Saharan Africa (sSA) resulting in missed diagnoses and delayed treatment. Additionally, data comparing cCMV prevalence in HIV-exposed and non-exposed infants is limited. We aimed to determine cCMV prevalence among HIV-exposed and -unexposed neonates in Uganda, describe associated clinical characteristics, and assess infant hearing outcomes. Methods This study was nested within a prospective cohort of pregnant women with and without HIV, followed with their infants through early childhood. Eligible participants were 18 years or older, pregnant, and planned to deliver at one of two clinics. We tested newborn saliva for CMV using a real-time PCR. Hearing screening was performed using a pre-approved screening algorithm. Maternal and neonatal medical characteristics and diagnoses were abstracted from clinical records. Results A total of 793 women and their newborns were enrolled. Mean maternal age was 28 (standard deviation [SD] 6) years, and parity was 3 (SD, 2.0). The mean birth weight was 3.0 (SD, 0.5) kilograms and gestational age was 37 (SD, 2.0) weeks. Overall, 677 out of 793 (84.7%) neonatal saliva samples were tested for cCMV, 23 out of 677 (3.4%) were positive with no difference by maternal HIV status. cCMV was not associated with failed hearing screen. However, lower one-minute Apgar and jaundice were associated with cCMV. Conclusion: cCMV prevalence was high in this Ugandan cohort and did not differ by HIV exposure. Hearing outcomes were similar by cCMV status. Future studies should include a comprehensive clinical and audiological assessment for both HIV-exposed and -unexposed neonates, and longitudinal follow-up to detect hearing loss and other cCMV-associated sequelae.