The impact of maternal HIV and malaria infection on the prevalence of congenital cytomegalovirus infection in Western Kenya

Abstract

BackgroundData on congenital cytomegalovirus (CMV) infection in Africa are limited. ObjectiveTo describe the prevalence of congenital CMV infection in a population with high prevalence of maternal HIV and malaria infection in western Kenya. Study designWe screened newborns for CMV by polymerase chain reaction assay of saliva swabs and dried blood spots (DBS), and assessed maternal CMV immunoglobulin G (IgG) status by testing serum eluted from newborn’s DBS. We calculated adjusted prevalence ratios (aPRs) using log-binomial regression models. ResultsAmong 1066 mothers, 210 (19·7%) had HIV infection and 207 (19·4%) had malaria infection; 33 (3·1%) mothers had both. Maternal CMV IgG prevalence was 93·1% (95% confidence interval [CI]: 88·3%–96·0%). Among 1078 newborns (12 sets of twins), 39 (3·6%, 95% CI: 2·7–4·9%) were CMV positive. The prevalence of congenital CMV infection by maternal HIV and malaria infection status was 5·0% (95% CI: 2·7–9·2%) for HIV only, 5·1% (95% CI: 2·7–9·4%) for malaria only, 8·8 (95% CI: 3·1–23·0) for HIV and malaria co-infection, and 2·6% (95% CI: 1·7–4·1%) for none. Congenital CMV infection was independently associated with maternal HIV infection (aPR=2·1; 95% CI: 1·0–4·2), adjusting for maternal age, parity, and malaria infection. ConclusionsThe prevalence of congenital CMV infection was higher than the 0·2–0·7% in developed countries. Maternal HIV infection may increase the risk of congenital CMV infection, but the role of maternal malaria on intrauterine transmission of CMV remains unclear.