Postnatal CMV acquisition risk is not increased among children who are HIV-exposed, uninfected versus HIV-unexposed in the setting of optimized maternal ART

HIV exposure in infants is not significantly linked to postnatal CMV acquisition (aHR=1.31, 95% CI 0.71–2.42) among children in Nairobi, Kenya with optimized maternal ART.

• Why it matters: Earlier studies showed higher and earlier CMV acquisition in HIV-exposed, uninfected children, but it was unclear whether this persists under universal ART and modern prophylaxis.
• What they did: Pregnant women without HIV and women living with HIV on ART for ≥6 months were followed with weekly infant sampling for 12 months; CMV DNA in infant urine, swabs, and plasma and maternal breast milk and swabs was analyzed using Kaplan-Meier and Cox models.
• The result: Although maternal breast milk and oral swab CMV DNA were associated with infant CMV hazard (aHR=2.80 and 1.35), CHEU status was not; cotrimoxazole prophylaxis (aHR=0.19) and recommended first-line postpartum ART (aHR=0.37) reduced hazard, with breast milk remaining a key source.

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