145. Low Vitamin D is Associated with Mother-to-Child-Transmission (MTCT) of Cytomegalovirus (CMV) in Women with HIV
Session: Poster Abstract Session: Big Viruses in Little People (Pediatric Viral Diseases)
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • IDSA 2016 VItD CMV 1.pdf (1.5 MB)
  • Background:

    CMV infection of the fetus or neonate via MTCT can lead to devastating disease, and there are no good prevention strategies to date. Vitamin D is a potent immunomodulator with antimicrobial effects, and plays an important role in placental immunity.

    Methods:

    This retrospective cohort study evaluated the impact of low maternal vitamin D on MTCT of CMV, including congenital (CMV+ test at 0-3 weeks), and peri/postnatal (CMV+ test at 3 weeks-6 months) infections, among HIV+, non-breastfeeding women and their infants from an urban HIV clinic. A vitamin D panel was performed on stored maternal plasma obtained near time of delivery. Infant CMV testing at 0-6 months included urine, oral, and blood, cultures and/or PCRs.

    Results:

    The cohort included 370 mother-baby pairs (births 1991-2014) with 12% (19/370) prevalence of MTCT (CMV+ test 0 to 6 months), 6% (19/323) with congenital, and 7% (25/339) with peri/postnatal CMV. Correlates of 25-hydroxyvitamin D (25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)D2), and MTCT were included in multivariate (MV) model selection. Higher 1,25(OH)D2 levels, the active form of vitamin D, were protective of overall MTCT in univariate (UV) analyses (OR 0.97 [95% CI 0.96-0.98] p < 0.0001) and MV (OR 0.96 [95% CI 0.95-0.98] p < 0.0001) analyses, controlling for birth year, delivery mode and maternal age. This protective effect was seen for both congenital infection (MV: OR 0.96 [95% CI 0.94-0.98] p < 0.0001) controlling for mom’s age, and birth year; and peri/postpartum infection (MV: OR 0.97 [95% CI 0.96-0.99] p=0.0002) controlling for delivery mode and birth year. Compared to women with 25(OH)D levels ≥31 ng/ml, women with levels <31 ng/ml had almost 5 times greater risk of congenital MTCT both in UV (OR 4.89 [95% CI 1.12-21.3] p=0.03) and MV analyses, controlling for mom’s age and birth year (OR 5.15 [95% CI 1.09-24.3] p=0.04). Maternal CD4 and HIV viral load were both significant correlates of 1,25(OH)D2 and 25(OH)D levels, but not associated with MTCT, and their inclusion in the MV models did not change the results.

    Conclusion:

    This study among HIV+ women is the first to find a link between lower maternal vitamin D and increased MTCT of CMV, including congenital CMV. Findings need to be replicated in an HIV negative population prior to generalizing results.

    Allison Bearden, MD/MPH1, Kristi Vanwinden, MD2, Naoko Kono, MPH3, Toni Frederick, PhD4, Eva Operskalski, PhD1, Alice Stek, MD5, Raj Pandian, PhD6, Lorayne Barton, MD7 and Andrea Kovacs, MD, FIDSA1, (1)Pediatrics, Maternal, Child, Adolescent/Adult Center for Infectious Diseases and Virology, University of Southern California, Los Angeles, CA, (2)Division of Maternal-Fetal Medicine, University of Southern California, Los Angeles, CA, (3)Preventative Medicine, University of Southern California, Los Angeles, CA, (4)Pediatrics, Maternal, Child, Adolescent/Adult Center for Infectious Diseases and Virology, University of Southern California, Los Angeles,, CA, (5)Division of Maternal-Fetal Medicine, Maternal Child Adolescent Center for Infectious Diseases and Virology, University of Southern California, Los Angeles, CA, (6)Pan Laboratories, Irvine, CA, (7)Neonatal Medicine, University of Southern California, Los Angeles, CA

    Disclosures:

    A. Bearden, None

    K. Vanwinden, None

    N. Kono, None

    T. Frederick, None

    E. Operskalski, None

    A. Stek, None

    R. Pandian, None

    L. Barton, None

    A. Kovacs, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.