1. 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.

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. 1.Evaluate transmission of CMV in children born to HIV positive/negative women. 2.Estimate CMV prevalence in children born to HIV positive women 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

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

6. Method (2) –Methodology 1.DNA extracted (Qiagen) from Whole Blood collected in EDTA tubes 2.« In House - Necker (Leruez-Ville 2007) » CMV quantitative real time PCR ABI Prism 7700 (Applied Biosystems) 3.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) 31 (45%) 38 (55%) CMV Negative CMV Positive CMV Prevalence in the studied population CMV distribution in the different groups All children of group 4 were breastfed Group 1,2 and 3 majority were bottle-fed Median age =15 wks [range 3-34 wks] N=69

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

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

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