Maternal Highly Active Antiretroviral Therapy Reduces Vertical Cytomegalovirus Transmission But Does Not Reduce Breast Milk Cytomegalovirus Levels

Authors

Jennifer A. Slyker, University of Washington
Barbra Richardson, University of Washington
Michael Chung, Aga Khan UniversityFollow
Claire Atkinson, Institute for Immunity and Transplantation, University College
Kristjana H. Ásbjörnsdóttir, University of Washington
Dara A. Lehman, University of Washington
Michael Boeckh, University of Washington
Vincent Emery, University of Surrey
James Kiarie, University of Nairobi
Grace John-Stewart, University of Washington

Document Type

Article

Department

Internal Medicine (East Africa)

Abstract

To evaluate the impact of highly active antiretroviral therapy (HAART) on CMV transmission and breast milk level in the context of maternal HIV. 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). 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. 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). HAART started during the third trimester may decrease infant CMV infections, by mechanisms independent of breast milk CMV levels. Clinical trials registration: NCT00167674.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

AIDS Research and Human Retroviruses

Recommended Citation

Slyker, J. A., Richardson, B., Chung, M., Atkinson, C., Ásbjörnsdóttir, K. H., Lehman, D. A., Boeckh, M., Emery, V., Kiarie, J., John-Stewart, G. (2017). Maternal Highly Active Antiretroviral Therapy Reduces Vertical Cytomegalovirus Transmission But Does Not Reduce Breast Milk Cytomegalovirus Levels. AIDS Research and Human Retroviruses, 33(4), 332-338.
Available at: https://ecommons.aku.edu/eastafrica_fhs_mc_intern_med/50