Cytomegalovirus Infection In Pediatric Aids
The role of cytomegalovirus (CMV) as an opportunistic infection in patients with AIDS in developed countries is well known; CMV has been associated with retinitis, enteritis, neuropathies, pneumonitis and other problems in patients with profound immunologic impairment due to advanced AIDS. Control of HIV infection with highly active antiretroviral therapy (HAART) in developed countries has led to improved immune function and greatly diminished role for CMV as an opportunistic pathogen. Although much less is known about CMV infection and HIV infection in developing countries, there is the potential for interaction with worsening of outcome for both infections. Transmission of CMV from mother to infant is common throughout the world, especially in countries where most mothers are seropositive for CMV and nurse their infants; many of the regions experiencing rapid growth in maternal and perinatal HIV infection would also be expected to have high rates of perinatal CMV infection. Studies of pregnant women show that shedding of CMV is increased in those with HIV infection, suggesting facilitation of transmission of CMV to the infant. Studies in infants of HIV infected mothers show a high rate of CMV infection, especially in infants who have perinatal HIV infection. A follow-up study of infants with perinatal HIV infection (performed in the pre-HAART era) showed an association between co-infection with CMV and progression of HIV to AIDS and development of CNS disease. The possibility that maternal HIV infection could increase the risk of prenatal transmission of CMV to the fetus is of great concern because of the rising rates of HIV infection in women worldwide. Although this potential problem has received very little attention, a controlled study performed in Brazil showed similar rates of congenital CMV infection in offspring of HIV infected and uninfected mothers. It will be important for studies in developing countries to examine more closely the effect of maternal HIV infection on transmission of CMV to the fetus and nursing infant and the consequences of CMV infection in the HIV infected child.
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, 百拇医药