Cytomegalovirus Urinary Shedding in HIV-infected Pregnant Women and Congenital Cytomegalovirus Infection

Clin Infect Dis. 2017 Aug 1;65(3):405-413. doi: 10.1093/cid/cix222.


Background: Cytomegalovirus (CMV) urinary shedding in pregnant women infected with human immunodeficiency virus (HIV) was evaluated to determine whether it poses an increased risk for congenital CMV infection (cCMV).

Methods: A subset of mother-infant pairs enrolled in the perinatal NICHD HPTN 040 study (distinguished by no antiretroviral use before labor) was evaluated. Maternal and infant urines were tested by qualitative real-time polymerase chain reaction (RT-PCR) for CMV DNA with quantitative RT-PCR performed on positive specimens.

Results: Urine specimens were available for 260 women with 85.4% from the Americas and 14.6% from South Africa. Twenty-four women (9.2%) had detectable CMV viruria by qualitative PCR. Maternal CMV viruria was not associated with mean CD4 cell counts or HIV viral load but was associated with younger maternal age (P = .02). Overall, 10 of 260 infants (3.8%) had cCMV. Women with detectable peripartum CMV viruria were more likely to have infants with cCMV than those without: 20.8% (5/24) versus 2.1% (5/236), (P = .0001). Women with CMV viruria had significantly higher rates of HIV perinatal transmission (29.2% vs. 8.1%, P = .002). They were 5 times (adjusted odds ratio [aOR] = 5.6, 95% confidence interval [CI] 1.9-16.8) and nearly 30 times (aOR, 29.7; 95% CI, 5.4-164.2) more likely to transmit HIV and CMV to their infants, respectively. Maternal gonorrhea (aOR, 19.5; 95% CI, 2.5-151.3) and higher maternal HIV log10 viral load (OR, 2.8; 95% CI, 1.3-6.3) were also significant risk factors for cCMV.

Conclusion: In this cohort of HIV-infected pregnant women not on antiretrovirals, urinary CMV shedding was a significant risk factor for CMV and HIV transmission to infants.

Clinical trials registration number: NCT00099359.

Keywords: CMV viruria; HIV; HIV perinatal transmission; congenital CMV; pregnancy.

Publication types

  • Clinical Trial, Phase III
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Cytomegalovirus Infections* / complications
  • Cytomegalovirus Infections* / congenital
  • Cytomegalovirus Infections* / urine
  • Cytomegalovirus Infections* / virology
  • Cytomegalovirus* / genetics
  • Cytomegalovirus* / isolation & purification
  • DNA, Viral / genetics
  • DNA, Viral / urine*
  • Female
  • HIV Infections / complications*
  • Humans
  • Infant, Newborn
  • Predictive Value of Tests
  • Pregnancy
  • Pregnancy Complications, Infectious* / urine
  • Pregnancy Complications, Infectious* / virology
  • Prevalence
  • Real-Time Polymerase Chain Reaction
  • Retrospective Studies
  • Risk Factors
  • Viral Load
  • Virus Shedding
  • Young Adult


  • DNA, Viral

Associated data