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Anfumbom KFUTWAH Virology Laboratory-CPC The Third ANRS Yaounde site scientific days June 15 th - 16 th 2009

Perinatal transmission of Cytomegalovirus (CMV) in children born to HIV positive and negative women in Cameroon. Anfumbom KFUTWAH Virology Laboratory-CPC The Third ANRS Yaounde site scientific days June 15 th - 16 th 2009 . CMV Infections.

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Anfumbom KFUTWAH Virology Laboratory-CPC The Third ANRS Yaounde site scientific days June 15 th - 16 th 2009

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  1. Perinatal transmission of Cytomegalovirus (CMV) in children born to HIV positive and negative women in Cameroon. Anfumbom KFUTWAH Virology Laboratory-CPC The Third ANRS Yaounde site scientific days June 15th - 16th 2009

  2. CMV Infections • CMV is a double stranded DNA virus of the Herpesviridae • CMV is one of the most successful human pathogens:>90% infections in the adult populations. • Asymptomatic in healthy population • Infections are lifelong and may be reactivated from time to time. • Severe Symptomatic cases occur. -congenitally infected children -Immuno-compromised patients (AIDS + transplant recipients) • Virus is excreted in body fluids (urine, saliva, breast milk, etc)

  3. Perinatal Infections due to CMV • CMV infections are highly prevalent in neonates, and are probably more common than all other perinatal infections combined • CMV infections can be acquired in utero, natally, or postnatally--and frequently are: • congenital: 0.6-2.4% live births • perinatal: 2-6% neonates • postnatal: up to 14-21% of neonates • (B.K English 2006) • The Influence of cytomegalovirus on the progression to AIDS in children especially in sub-Saharan Africa (including Cameroon) is uncertain

  4. Study Objectives Set-up CMV diagnosis (real time PCR) in a framework of an ANRS sponsored project in Cameroon –PediaCam. One of the goals of PediaCam: Evaluate the feasibility of early administration of antiretroviral drugs to HIV infected children • Evaluate transmission of CMV in children born to HIV positive/negative women. • Estimate CMV prevalence in children born to HIV positive women

  5. Method (1) Not followed-up ≤7months old Followed-up from birth Followed-up from birth HIV Diagnosis at 6 weeks HIV Negative Children HIV Positive Children HIV Negative Children HIV Positive Children Group 1i n=17 Group 2 n=11 Group 3 n=29 Group 4 n=12 • Studied Population: Children born to HIV Positive Women Children born to HIV Negative Women

  6. Method (2) • Methodology • DNA extracted (Qiagen) from Whole Blood collected in EDTA tubes • « In House - Necker (Leruez-Ville 2007)» CMV quantitative real time PCR ABI Prism 7700 (Applied Biosystems) • Using the Taqman technology • Gene used : Exon 4 of the major immediate-early (MIE) gene • Primers:123 EX4 S and 123 EX4 AS • Probes marked FAM-TAMRA • CMV standards (CMV AD 169)

  7. Results (1) CMV Prevalence in the studied population 31 (45%) Median age =15 wks [range 3-34 wks] N=69 CMV Negative CMV Positive 38 (55%) CMV distribution in the different groups • All children of group 4 were breastfed • Group 1,2 and 3 majority were bottle-fed

  8. Results (2) CMV distribution according to mode of feeding CMV Prevalence higher in breastfed than in bottle-fed children 21/33 7/34 CMV distribution according to mode of feeding and HIV status Approx. 30% increase in CMV prevalence in HIV positive children in both breastfed and bottle fed children

  9. Results (3) CMV viral load distribution in the different groups Median viral load is 3,6log copies/ml Group 3 has highest median CMV viral load of 4,6 log. CMV detection among symptomatic children in group 3 • Common symptoms included: • Chronic diarrhoea • Oral Candidiasis • Upper respiratory infections • Rhino bronchitis • Pneumonia • Sepsis • Etc

  10. Conclusion and Perspectives • Breastfeeding associated with CMV infection • HIV infection associated with CMV infections • Most HIV symptomatic children are also CMV positive (co-infection with CMV could contribute to the high morbility and mortality observed in HIV infection in Africa) The future • Establish the role of congenital CMV infection in Cameroon? • What are the effects of ARV Treatment on CMV in children co-infected with CMV/HIV?

  11. Acknowledgement Centre Pasteur Du Cameroon Mathurin Tejiokem Matial Yonga Pascal Boisier Dominique Rousset Centre Pasteur Du Cameroon Mathurin Tejiokem Matial Yonga Pascal Boisier Dominique Rousset Hôpital Necker Enfants Malades Stephane Blanche Christine Rouzioux Marianne Leruez-Ville Hôpital Necker Enfants Malades Stephane Blanche Christine Rouzioux Marianne Leruez-Ville PediaCam (ANRS 12140) study team Centre Mère et Enfant de la Fondation Chantal Biya Francis Ateba Jean Ndogo Georgette Guekam Centre Mère et Enfant de la Fondation Chantal Biya Francis Ateba Jean Ndogo Georgette Guekam Hôpital Robert Debré, Service de Pédiatrie Générale Albert Faye Unité Inserm U822, CHU de Bicêtre Josiane Warszawski Unité Inserm U822, CHU de Bicêtre Josiane Warszawski Centre Hospitalier d’Essos à Yaoundé Chantal Same-Ekobo Centre Hospitalier d’Essos à Yaoundé Chantal Same-Ekobo

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