The prevalence and significance of CMV DNAemia in young children in South Africa
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The prevalence and significance of CMV DNAemia in young children in South Africa
Author: Hsiao NY1, Hardie DR1, Morrow B2, Zampoli M2, Zar HJ2
1Division of Medical Virology, Groote Schuur Hospital, University of Cape Town, South Africa; 2School of Child and Adolescent Health, Red Cross Children's Hospital, University of Cape Town, South Africa

Primary CMV infection in Sub-Saharan Africa occurs in infancy. While mostly asymptomatic in HIV uninfected individuals, infants co-infected with HIV are at risk of developing severe disseminated CMV disease. Molecular assays have been used very effectively to detect and monitor CMV disease in adult post transplant setting. However, little data is available on the use of these techniques in HIV-infected infants.

Aim: To assess the level of CMV DNAemia in young children with and without suspected CMV disease by qualitative and quantitative CMV PCR.

Methods: Qualitative CMV PCR was used to screen whole blood samples of HIV exposed, HIV uninfected children. Quantitative CMV PCR (Qiagen RealArt CMV LC PCR) was performed on the CMV PCR positive children. HIV-infected infants with suspected CMV pneumonia were tested with the same CMV viral load assay for comparison.

Results: 118 children with median age of 5 months were screened (range 1-17 months); 26 (22.9%) were CMV PCR positive. In these healthy, CMV PCR positive children, the blood CMV viral load was 3.43 ± 0.99 log c/ml (Mean ± SD). In the 22 infants with suspected CMV disease (median age 3 months, range1-5 months), the blood viral load was 4.49 ± 0.86 log c/ml (Mean ± SD), significantly higher than the healthy group (p=0.0003).

Conclusion: Asymptomatic CMV viraemia is common among HIV exposed young children in South Africa. A quantitative CMV PCR may play a role in differentiating those with CMV disease from infection. A larger outcome-based clinical study is under way to confirm these results.

 

 

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