CYTOMEGALOVIRUS
INFECTION IN PEDIATRIC AIDS
Pass,
RF
UAB
School of Medicine, Birmingham, Alabama, USA
The role
of cytomegalovirus (CMV) as an opportunistic infection in patients with
AIDS in developed countries is well known; CMV has been associated with
retinitis, enteritis, neuropathies, pneumonitis and other problems in
patients with profound immunologic impairment due to advanced AIDS. Control of HIV
infection with highly active antiretroviral therapy (HAART) in developed
countries has led to improved immune function and greatly diminished role
for CMV as an opportunistic pathogen.
Although much less is known about CMV infection and HIV infection in
developing countries, there is the potential for interaction with worsening
of outcome for both infections.
Transmission of CMV from mother to infant is common throughout the
world, especially in countries where most mothers are seropositive for CMV
and nurse their infants; many of the regions experiencing rapid growth in
maternal and perinatal HIV infection would also be expected to have high
rates of perinatal CMV infection. Studies of pregnant women show that shedding of
CMV is increased in those with HIV infection, suggesting facilitation of
transmission of CMV to the infant.
Studies in infants of HIV infected mothers show a high rate of CMV
infection, especially in infants who have perinatal HIV infection. A follow-up study of infants with
perinatal HIV infection (performed in the pre-HAART era) showed an
association between co-infection with CMV and progression of HIV to AIDS
and development of CNS disease. The possibility that maternal HIV infection
could increase the risk of prenatal transmission of CMV to the fetus is of
great concern because of the rising rates of HIV infection in women
worldwide. Although this
potential problem has received very little attention, a controlled study
performed in Brazil showed similar rates of congenital CMV infection in
offspring of HIV infected and uninfected mothers. It will be important for studies in
developing countries to examine more closely the effect of maternal HIV
infection on transmission of CMV to the fetus and nursing infant and the
consequences of CMV infection in the HIV infected child.