Cytomegalovirus co-infection with HIV in children and adolescents on antiretroviral therapy in Abuja, Nigeria

Abstract

Background: Cytomegalovirus (CMV) co-infection with human  immunodeficiency virus (HIV) is known to accelerate HIV disease  progression. It has the potential of being a killer disease or a silent  lifetime companion in HIV patients. There is dearth of information on CMV prevalence among HIV infected children and adolescents in our  environment. We therefore conducted this study to determine its sero-prevalence, and risk factors for co-infection among HIV infected children and adolescents on highly active antiretroviral therapy (HAART) in our center.

Method: A descriptive cross sectional study of HIV-infected children and adolescents aged 2 months to 18 years on HAART was conducted over a 6 month period between October 2017 and March 2018 in our health facility. Blood samples of subjects were screened for CMV IgM using commercial test kits. Biodata of subjects, CD4 cell count, and viral load were collected into a designed proforma, and statistical analysis was done with SPSS version 22.0.

Result: A total of 161 HIV-infected children and adolescents were recruited, 103 (64.0%) were males, 83 (51.6%) were between the ages of 5 and <10 years, 113 (70.2%) were from lower socio-economic class, and 138 (85.7%) were on 1st line HAART. Of the 17 (10.6%) subjects positive for CMV IgM, 3 (17.6%) were less than 5 years old, 11 (64.7%) were between the ages of 5-10 years, and none was older than 15 years. Univariate analysis showed significant differences in the mean age, weight, length/height, and systolic blood pressure between CMV IgM positive and negative patients (p<0.05), but no significant difference in gender, socioeconomic class, types of antiretroviral drugs, CD4 cell count, and viral load (p>0.05). Multivariate analysis however did not show any significant difference in age, weight, length/height, and systolic blood pressure.

Conclusion: The prevalence of active CMV infections among HIV infected children and adolescents on HAART in our centre is high. Low CD4 cell count and high viral load were not associated with active CMV disease, and no risk factor for co-infection was also identified. Identifying those with primary/active infection will be necessary for possible treatment with anti-herpes drugs before development of reactivated CMV disease.

Keywords: CMV; HIV; co-infection; anti-retroviral; children; adolescents