Cytomegalovirus infection and HIV-1 disease progression in infants born toHIV-1-infected women

Background and Methods Cytomegalovirus (CMV) has been implicated as a cofac tor in the progression of human immunodeficiency virus type 1 (HIV-1) disea se. We assessed 440 infants (75 of whom were HIV-1-infected and 365 of whom were not) whose CMV status was known, who were born to HIV-1-infected wome n, and who were followed prospectively. HIV-1 disease progression was defin ed as the presence of class C symptoms (according to the criteria of the Ce nters for Disease Control and Prevention [CDC]) or CD4 counts of less than 750 cells per cubic millimeter by 1 year of age and less than 500 cells per cubic millimeter by 18 months of age. Results At birth the frequency of CMV infection was similar in the HIV-1-in fected and HIV-1-uninfected infants (4.3 percent and 4.5 percent, respectiv ely), but the HIV-1-infected infants had a higher rate of CMV infection at six months of age (39.9 percent vs. 15.3 percent, P=0.001) and continued to have a higher rate of CMV infection through four years of age (P=0.04). By 18 months of age, the infants with both infections had higher rates of HIV -1 disease progression (70.0 percent vs. 30.4 percent, P=0.001), CDC class C symptoms or death (52.5 percent vs. 21.7 percent, P=0.008), and impaired brain growth or progressive motor deficits (35.6 percent vs. 8.7 percent, P =0.005) than infants infected only with HIV-1. In a Cox regression analysis , CMV infection was associated with an increased risk of HIV-1 disease prog ression (relative risk, 2.59; 95 percent confidence interval, 1.13 to 5.95) . Among children infected with HIV-1 alone, but not among those infected wi th both viruses, children with rapid progression of HIV-1 disease had highe r mean levels of HIV-1 RNA than those with slower or no progression of dise ase. Conclusions HIV-1-infected infants who acquire CMV infection in the first 1 8 months of life have a significantly higher rate of disease progression an d central nervous system disease than those infected with HIV-1 alone. (N E ngl J Med 1999;341:77-84.) (C) 1999, Massachusetts Medical Society.