Cytomegalovirus Shedding in Brazilian Pregnant Women Living With HIV on Combination Antiretrovirals and CMV Infection in Infants

BACKGROUND: Cytomegalovirus (CMV) shedding among CMV-seropositive women living with HIV (WLHIV) on combination antiretroviral therapy (cART) and its impact on infant CMV infection in non-breastfeeding settings remains unclear. We assessed maternal CMV urinary shedding from pregnancy through 6 weeks postpartum and determined the timing and incidence of infant CMV transmission over 12 months. METHODS: Data from 150 CMV-seropositive pregnant WLHIV receiving cART and 122 non-breastfed infants enrolled in a cohort study were analyzed. CMV-DNA was measured in maternal and infant urine using real-time polymerase chain reaction. The incidence of maternal and infant viral shedding and its correlates were analyzed. RESULTS: Twenty-nine of the 150 women (19.3%; 95% confidence interval [CI]: 13.0%-25.6%) shed CMV-DNA (median 2.44 log10copies/mL). Shedding was independently associated with illicit substance(s) use during pregnancy (adjusted odds ratio [aOR] = 6 .3) and lymphocyte CD4+ counts <350 cells/mm3 (aOR = 8.2). Among 122 infants, 5 (4.1%; 95% CI: 1.3%-9.3%) had congenital cytomegalovirus (cCMV)-2 confirmed and 3 presumed-and 12 (10.3%; 95% CI: 5.4%-17.2%) had perinatal or postnatal (Pe/Pn) CMV infection. Correlates of cCMV included maternal viral shedding and household crowding (>2 people per room). Low (<350 cells/mm3) maternal CD4+ counts at 6 weeks postpartum were associated with perinatal/postnatal CMV. CONCLUSIONS: The risk of CMV replication and transmission persists among WLHIV despite cART. The association of cCMV with maternal shedding and social determinants highlights the need for enhanced immune monitoring and targeted screening, as CMV risk remains significant in WLHIV in high-seroprevalence populations.