114. Birth Prevalence of Congenital Cytomegalovirus Infection and Language, Hearing and Developmental Outcomes in a Cohort of HIV-Exposed, Uninfected Preschool Children
Session: Oral Abstract Session: Infant Viral Infections
Thursday, October 4, 2018: 8:45 AM
Room: S 156

Background: The prevalence of congenital cytomegalovirus infection (cCMV) at birth is 0.5-1% in the US. Most cCMV newborns are asymptomatic at birth with 10-15% subsequently developing sequelae, such as hearing loss. Higher cCMV prevalence (2.5-11.4%) is reported in infants born to HIV-infected women, associated with maternal immune suppression and lack of antiretroviral therapy (ART), with few studies addressing neurodevelopmental (ND) outcomes in their offspring. We report birth prevalence of cCMV in a cohort of HIV-exposed, uninfected infants (HEU) born to women on combination ART with well-controlled HIV and describe ND outcomes through age five years.

Methods: The Surveillance Monitoring for ART Toxicities (SMARTT) study is an ongoing NICHD-funded observational multi-centered cohort study (US and Puerto Rico) of growth and development of HEU children that commenced in 2007. As of 8/1/2017, participants with stored blood pellets collected ≤ 3 weeks after birth and at least one ND assessment ≥ 1 year of age had pellets tested by DNA PCR to establish cCMV. Comparisons of ND outcomes (defined in figure 1) at ages 1, 2 and 5 by cCMV status were made using Wilcoxon and Fisher’s Exact tests.  

Results: Of 895 children meeting study criteria (55% black; 32% white; 40% Latino), 8 had cCMV, yielding a birth prevalence of 0.89% (95% CI: 0.39-1.75%). All were asymptomatic and similar to CMV uninfected infants in gestational age and anthropometric measurements at birth. The last HIV viral load prior to delivery was undetectable in 88% of women. The last available CD4% was <20% in 3/8 mothers of cCMV newborns compared to 112/873 in those without (38% vs, 13%, p<0.07). The mean duration of follow-up (± standard deviation) of children with cCMV was 7.2 yrs (1.6) and those without, 5.9 yrs (2.3) years (p<0.11). ND assessments for language development (CDI at 1, A&S at 2, TOLD-P:3 at 5), cognition (Bayleys-III at 1), intelligence (WPPSI-III at 5), and hearing (PTA at 5) did not differ by cCMV status (figure 1).

Conclusion: Birth prevalence of cCMV in HEU children born within the last decade approaches national US prevalence. Preschool HEU children with asymptomatic cCMV at birth did not show poorer language, hearing and developmental outcomes compared to CMV uninfected HEU children.     

Murli Purswani, MD1, Tzy-Jyun Yao, PhD2, Jonathan S. Russell, MPH2, Kathleen Malee, PhD3, Stephen A. Spector, MD, FIDSA4, Paige Williams, PhD5, Toni Frederick, PhD6, Sandra Burchett, MD, MS7, Monika Dietrich, MD8, Sean Redmond, PhD9, Howard Hoffman, MA10, Peter Torre III, PhD11, Sonia Lee, PhD12, Mabel Rice, PhD13 and For the Pediatric HIV/AIDS Cohort Study (PHACS), (1)BronxCare Health System, Bronx, NY, (2)Harvard T.H. Chan School of Public Health, Boston, MA, (3)Northwestern Feinberg School of Medicine, Chicago, IL, (4)Pediatrics, University of California, San Diego, La Jolla, CA, (5)Harvard T.H. Chan School of Public Health Departments of Biostatistics and Epidemiology, Boston, MA, (6)Research Pediatrics, University of Southern California, Los Angeles, CA, (7)Boston Children's Hospital, Boston, MA, (8)Tulane University, New Orleans, LA, (9)University of Utah, Salt Lake City, UT, (10)NIDCD, NIH, Bethesda, MD, (11)San Diego State University, San Diego, CA, (12)NICHD, NIH, Bethesda, MD, (13)University of Kansas, Lawrence, KS


M. Purswani, None

T. J. Yao, None

J. S. Russell, None

K. Malee, None

S. A. Spector, None

P. Williams, None

T. Frederick, None

S. Burchett, None

M. Dietrich, None

S. Redmond, None

H. Hoffman, None

P. Torre III, None

S. Lee, None

M. Rice, None

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