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Article ; Online: Cytomegalovirus viremia in hiv-exposed and hiv-unexposed infants in malawi

Giuliano, Marina / Pirillo, Maria Franca / Orlando, Stefano / Luhanga, Richard / Mphwere, Robert / Kavalo, Thom / Andreotti, Mauro / Amici, Roberta / Ciccacci, Fausto / Marazzi, M. C. / Floridia, Marco

Acta Tropica. 2023 July 14, p.106987-

2023 , Page(s) 106987–

Abstract: In sub-Saharan Africa the great majority of infants acquire Cytomegalovirus (CMV) infection within the first year of life. Maternal long-term antiretroviral therapy (ART) has been suggested to reduce the rate of CMV acquisition in HIV-exposed infants. In ...

Abstract	In sub-Saharan Africa the great majority of infants acquire Cytomegalovirus (CMV) infection within the first year of life. Maternal long-term antiretroviral therapy (ART) has been suggested to reduce the rate of CMV acquisition in HIV-exposed infants. In the present study serum samples collected at 6 months of age from HIV-exposed and HIV-unexposed infants were analyzed for the presence of CMV DNA (with CMV positivity defined by levels of CMV DNA > 1000 UI/ml). Twenty out of 58 (34.5%) infants had CMV DNA > 1000 UI/ml. There was no difference in the prevalence of CMV viremia between HIV-exposed and -unexposed infants [33.3% (15/45) vs 38.5% (5/13), respectively, P = 0.488]. In the HIV-exposed group, mothers of CMV-negative infants had received a longer antiretroviral treatment before delivery in comparison to mothers of CMV-positive infants (28 vs 3 months, P = 0.187). No differences in weights and lengths at birth, and at 1, 6 and 12 months were observed between CMV-positive and CMV-negative infants. In this study, the prevalence of CMV viremia at six months of age was high in infants born to HIV-positive mothers receiving long-term ART, similar to that of HIV-unexposed infants. Considering the possible relevant impact of CMV on infant health, strategies for containment of the infection should be explored.
Keywords	Cytomegalovirus ; DNA ; antiretroviral agents ; blood serum ; therapeutics ; viremia ; Sub-Saharan Africa ; CMV DNA ; HIV-exposed infant ; Malawi
Language	English
Dates of publication	2023-0714
Publishing place	Elsevier B.V.
Document type	Article ; Online
Note	Pre-press version
ZDB-ID	210415-5
ISSN	1873-6254 ; 0001-706X
ISSN (online)	1873-6254
ISSN	0001-706X
DOI	10.1016/j.actatropica.2023.106987
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: A 12-month Prospective Study of HIV-infected and HIV-uninfected Women and Their Infants in Malawi: Comparative Analysis of Clinical Events and Infant Growth.

Floridia, Marco / Orlando, Stefano / Andreotti, Mauro / Mphwere, Robert / Kavalo, Thom / Ciccacci, Fausto / Scarcella, Paola / Marazzi, Maria Cristina / Giuliano, Marina

The American journal of tropical medicine and hygiene

2022 Volume 108, Issue 2, Page(s) 394–402

Abstract: Few studies have compared clinical outcomes in HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HUU) infants in the current scenario of universal and lifelong maternal antiretroviral therapy (ART). HIV-uninfected and HIV-infected Malawian women ...

Abstract	Few studies have compared clinical outcomes in HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HUU) infants in the current scenario of universal and lifelong maternal antiretroviral therapy (ART). HIV-uninfected and HIV-infected Malawian women receiving ART and their breastfed infants were followed for 12 months postpartum, analyzing the rates of infectious and noninfectious events and assessing infant growth at 6 weeks, 6 months, and 12 months. The cohorts included 227 mothers (70 HIV-negative, 157 HIV-positive) and 235 infants (72 HUU, 163 HEU). No maternal or infant deaths occurred during follow-up. HIV-negative women were less likely to complete follow-up (48.6% versus 91.1%). Mothers with and without HIV had similar rates of both infectious and noninfectious events per person-month. Infants who were HEU, compared with HUU, had higher rates of events of any type, lower respiratory tract infections (LRTI), and noninfectious events. HEU had lower body mass index (BMI) at 6 weeks but did not differ from HUU in all anthropometric measures at 6 and 12 months; in growth between 6 weeks and 12 months; and in occurrence of stunting, underweight, and wasting at 6 weeks, 6 months, and 12 months. During the first year of life, infants who were HEU, compared with HUU, showed a transiently lower BMI and an increased risk of LRTI.
MeSH term(s)	Infant ; Humans ; Female ; Prospective Studies ; Malawi/epidemiology ; HIV Infections/complications ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Breast Feeding ; Communicable Diseases ; Respiratory Tract Infections
Language	English
Publishing date	2022-12-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.22-0482
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Article ; Online: Maternal retention and early infant HIV diagnosis in a prospective cohort study of HIV-positive women and their children in Malawi.

Giuliano, Marina / Orlando, Stefano / Andreotti, Mauro / Mthiko, Bryan / Mphwere, Robert / Kavalo, Thom / Ciccacci, Fausto / Marazzi, Maria Cristina / Floridia, Marco

International journal of STD & AIDS

2022 Volume 34, Issue 1, Page(s) 54–61

Abstract: Background: Post-partum loss to follow-up and lack of early HIV infant diagnosis (EID) can significantly affect the efficiency of programs for the prevention of mother-to-child transmission.: Methods: In a prospective observational study 167 women ... ...

Abstract	Background: Post-partum loss to follow-up and lack of early HIV infant diagnosis (EID) can significantly affect the efficiency of programs for the prevention of mother-to-child transmission. Methods: In a prospective observational study 167 women were enrolled at week 36 of gestation and followed with their infants up to one year after delivery. Retention was defined as the proportion of women who attended the 12 months visit and EID as an HIV PCR test performed within 2 months. Determinants for retention and EID were assessed in univariate analyses and in multivariable logistic regression models. Results: Women lost to follow-up (24/167 or 14.4%) had a shorter duration of antiretroviral therapy (ART) at enrolment in comparison to women retained in care ( Conclusions: Longer duration of ART at enrolment significantly predicted a better post-partum retention, suggesting that specific counselling interventions should be targeted to recent ART initiators. A low proportion of infants did not receive an EID, but predictive factors were difficult to identify.
MeSH term(s)	Infant ; Female ; Humans ; Pregnancy ; Prospective Studies ; Malawi/epidemiology ; Infectious Disease Transmission, Vertical/prevention & control ; HIV Infections/diagnosis ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Early Diagnosis ; Pregnancy Complications, Infectious/diagnosis ; Pregnancy Complications, Infectious/drug therapy ; Pregnancy Complications, Infectious/epidemiology
Language	English
Publishing date	2022-10-26
Publishing country	England
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1018089-8
ISSN	1758-1052 ; 0956-4624
ISSN (online)	1758-1052
ISSN	0956-4624
DOI	10.1177/09564624221136647
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Article ; Online: Micronutrient and Nutritional Status of HIV-Exposed and HIV-Unexposed Malawian Infants in the First Year of Life: Assessment of Ferritin, Vitamin A, and D Status and Its Association with Growth.

Floridia, Marco / Galluzzo, Clementina Maria / Orlando, Stefano / Luhanga, Richard / Mphwere, Robert / Kavalo, Thom / Andreotti, Mauro / Amici, Roberta / Ciccacci, Fausto / Marazzi, Maria Cristina / Giuliano, Marina

Nutrients

2023 Volume 15, Issue 14

Abstract: Breastfed Malawian infants from Human Immunodeficiency Virus (HIV)-uninfected and HIV-infected women who received antiretroviral therapy were followed until 12 months of age, allowing us to evaluate plasma levels of ferritin, vitamin A (as retinol- ... ...

Abstract	Breastfed Malawian infants from Human Immunodeficiency Virus (HIV)-uninfected and HIV-infected women who received antiretroviral therapy were followed until 12 months of age, allowing us to evaluate plasma levels of ferritin, vitamin A (as retinol-binding protein, RBP), and vitamin D (25(OH)D) at six months, as well as nutritional status and growth between six and 12 months. Ferritin and RBP levels were adjusted for inflammation. The study included 88 infants, 63 of whom were part of a recent cohort (2019-2021) that included 49 HIV-exposed but uninfected (HEU) and 14 HIV-unexposed and uninfected (HUU) infants, as well as 25 infants (all HEU) from an earlier cohort (2008-2011). No differences were observed between HEU and HUU infants regarding micronutrient levels, anthropometric indexes, growth, and rates of stunting, being underweight, or wasting. HEU infants from the earlier cohort, when compared to more recent HEU infants, had significantly worse anthropometric measures at six months and inferior growth between six and twelve months. Overall, ferritin deficiency involved 68.6% of infants, while vitamin A and vitamin D deficiency involved 8% and 1.2% of infants, respectively. Micronutrient deficiencies were not associated with HIV exposure, cohort, stunting, being underweight, or wasting. At six months, stunting, being underweight, and wasting involved 25.0%, 2.7% and 2.8% of infants, respectively, with no differences related to HIV exposure. Ferritin deficiency at six months was associated with inferior subsequent growth. In this small observational study conducted in Malawian infants, no major nutritional gap was observed between HIV-exposed and HIV-unexposed infants, though the study highlighted specific nutritional deficiencies that deserve attention. High rates of stunting and ferritin deficiency were observed in the first year of life in Malawian infants, irrespective of maternal HIV status; a significant association between ferritin deficiency and worse subsequent growth was found. Vitamin A and vitamin D deficiencies were much less frequent. Based on the data observed, nutritional interventions should give priority to the correction of ferritin deficiency and chronic undernutrition.
MeSH term(s)	Humans ; Infant ; Female ; Nutritional Status ; Vitamin A ; HIV ; Ferritins ; Micronutrients ; Thinness/complications ; HIV Infections/complications ; HIV Infections/epidemiology ; Trace Elements ; Growth Disorders/etiology ; Growth Disorders/complications ; Malnutrition/complications ; Cachexia/complications ; Vitamin D Deficiency/complications
Chemical Substances	Vitamin A (11103-57-4) ; Ferritins (9007-73-2) ; Micronutrients ; Trace Elements
Language	English
Publishing date	2023-07-24
Publishing country	Switzerland
Document type	Observational Study ; Journal Article
ZDB-ID	2518386-2
ISSN	2072-6643 ; 2072-6643
ISSN (online)	2072-6643
ISSN	2072-6643
DOI	10.3390/nu15143282
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Article: Rates of Seroprotection against Vaccine-Preventable Infectious Diseases in HIV-Exposed and -Unexposed Malawian Infants.

Baroncelli, Silvia / Galluzzo, Clementina Maria / Orlando, Stefano / Pirillo, Maria Franca / Luhanga, Richard / Mphwere, Robert / Kavalo, Thom / Amici, Roberta / Floridia, Marco / Andreotti, Mauro / Ciccacci, Fausto / Scarcella, Paola / Marazzi, Maria Cristina / Giuliano, Marina

Pathogens (Basel, Switzerland)

2023 Volume 12, Issue 7

Abstract: Background: The evaluation of seroprotection rates against vaccine-preventable infectious diseases allows for the identification of risk populations. HIV-exposed infants, even if not infected with HIV, have higher morbidity and mortality in comparison ... ...

Abstract	Background: The evaluation of seroprotection rates against vaccine-preventable infectious diseases allows for the identification of risk populations. HIV-exposed infants, even if not infected with HIV, have higher morbidity and mortality in comparison to unexposed counterparts. The aim of this study was to compare the specific IgG levels against Methods: Blood samples from 62 infants, 49 HIV-exposed, uninfected (HEU), and born to women living with HIV and 13 HIV-unexposed and uninfected (HUU), were collected at 6 months, and specific IgG levels were determined using ELISA tests. Results: The antibody levels against HiB, HBV, and Spn were similar in the two groups. At six months, all HUU infants and 81.6% of HEU infants showed seroprotective levels against HiB, while a percentage of protection varying from 80.6 to 84.6% was observed for HBV and Spn regardless of HIV exposure. Only 59.2% of HEU and 69.2% of HUU infants showed antibody protection against all three pathogens. Conclusions: These results indicate similar rates of seroprotection among HEU and HUU infants but also suggest that a consistent fraction of infants received incomplete vaccinations. Strategies to enforce participation in immunization programs in Malawi should be a health priority.
Language	English
Publishing date	2023-07-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2695572-6
ISSN	2076-0817
ISSN	2076-0817
DOI	10.3390/pathogens12070938
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Article ; Online: Cytomegalovirus viremia in HIV-exposed and HIV-unexposed infants in Malawi.

Acta tropica

2023 Volume 246, Page(s) 106987

Abstract	In sub-Saharan Africa the great majority of infants acquire Cytomegalovirus (CMV) infection within the first year of life. Maternal long-term antiretroviral therapy (ART) has been suggested to reduce the rate of CMV acquisition in HIV-exposed infants. In the present study serum samples collected at 6 months of age from HIV-exposed and HIV-unexposed infants were analyzed for the presence of CMV DNA (with CMV positivity defined by levels of CMV DNA > 1000 UI/ml). Twenty out of 58 (34.5%) infants had CMV DNA > 1000 UI/ml. There was no difference in the prevalence of CMV viremia between HIV-exposed and -unexposed infants [33.3% (15/45) vs 38.5% (5/13), respectively, P = 0.488]. In the HIV-exposed group, mothers of CMV-negative infants had received a longer antiretroviral treatment before delivery in comparison to mothers of CMV-positive infants (28 vs 3 months, P = 0.187). No differences in weights and lengths at birth, and at 1, 6 and 12 months were observed between CMV-positive and CMV-negative infants. In this study, the prevalence of CMV viremia at six months of age was high in infants born to HIV-positive mothers receiving long-term ART, similar to that of HIV-unexposed infants. Considering the possible relevant impact of CMV on infant health, strategies for containment of the infection should be explored.
MeSH term(s)	Infant, Newborn ; Female ; Humans ; Infant ; Pregnancy ; Cytomegalovirus ; Viremia/drug therapy ; Malawi/epidemiology ; Infectious Disease Transmission, Vertical ; Cytomegalovirus Infections/epidemiology ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Pregnancy Complications, Infectious/drug therapy ; Pregnancy Complications, Infectious/epidemiology
Language	English
Publishing date	2023-07-14
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	210415-5
ISSN	1873-6254 ; 0001-706X
ISSN (online)	1873-6254
ISSN	0001-706X
DOI	10.1016/j.actatropica.2023.106987
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Article ; Online: Insufficient measles antibody protection in 6-month-old Malawian infants: Reconsider vaccination schedule?

Baroncelli, Silvia / Galluzzo, Clementina Maria / Orlando, Stefano / Luhanga, Richard / Mphwere, Robert / Kavalo, Thom / Amici, Roberta / Floridia, Marco / Andreotti, Mauro / Ciccacci, Fausto / Marazzi, Maria Cristina / Giuliano, Marina

Tropical medicine & international health : TM & IH

2023 Volume 28, Issue 9, Page(s) 731–735

Abstract: Measles vaccination is currently recommended at 9 months, since maternal antibodies are supposed to protect infants until that age. In this study of 6-month-old Malawian infants 98.3% (58/59) had non-protective IgG levels against measles, irrespective of ...

Abstract	Measles vaccination is currently recommended at 9 months, since maternal antibodies are supposed to protect infants until that age. In this study of 6-month-old Malawian infants 98.3% (58/59) had non-protective IgG levels against measles, irrespective of HIV exposure. Anticipating the first dose at 6 months could be considered.
MeSH term(s)	Humans ; Infant ; Measles/prevention & control ; Vaccination ; Antibodies, Viral ; Immunization Schedule ; Measles Vaccine
Chemical Substances	Antibodies, Viral ; Measles Vaccine
Language	English
Publishing date	2023-08-02
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1314080-2
ISSN	1365-3156 ; 1360-2276
ISSN (online)	1365-3156
ISSN	1360-2276
DOI	10.1111/tmi.13920
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Article ; Online: Immunoglobulin G passive transfer from mothers to infants: total IgG, IgG subclasses and specific antipneumococcal IgG in 6-week Malawian infants exposed or unexposed to HIV.

Baroncelli, Silvia / Galluzzo, Clementina M / Orlando, Stefano / Mphwere, Robert / Kavalo, Thom / Luhanga, Richard / Amici, Roberta / Floridia, Marco / Andreotti, Mauro / Ciccacci, Fausto / Marazzi, Maria Cristina / Giuliano, Marina

BMC infectious diseases

2022 Volume 22, Issue 1, Page(s) 342

Abstract: Background: The impaired transplacental passage of IgG from mothers living with HIV to their infants could be one of the causes of the high vulnerability to infections of HIV-exposed uninfected (HEU) infants, but controversial results have been obtained ...

Abstract	Background: The impaired transplacental passage of IgG from mothers living with HIV to their infants could be one of the causes of the high vulnerability to infections of HIV-exposed uninfected (HEU) infants, but controversial results have been obtained in different settings. The aim of this study was to assess in 6-week old HEU and HIV-unexposed, uninfected (HUU) Malawian infants the total IgG levels, the subclasses profile and the concentrations of global anti-pneumococcal capsular polysaccharide (anti-PCP) IgG and IgG2. Methods: Dried blood spots were collected from 80 infants (40 HEU, 40 HUU) and antibodies concentrations determined by nephelometric method (total IgG and subclasses), or using ELISA (anti-PCP total IgG and IgG2). Results are expressed as median levels with IQR, while the proportions of each subclass out of the total IgG are used to describe the subclasses profile. Results: At 6 weeks HEU infants had higher median levels of total IgG and IgG1 and a significantly lower level of IgG2 [0.376 (0.344-0.523) g/l vs 0.485 (0.374-0.781) g/l, p = 0.037] compared to the HUU counterparts. The IgG subclasses distribution confirmed the underrepresentation of IgG2 (IgG2 represented 5.82% of total IgG in HEU and 8.87% in HUU). The anti-PCP IgG and IgG2 levels were significantly lower in HEU infants [8.9 (5.4-15.1) mg/l vs 16.2 (9.61-25.8) mg/l in HUU, p < 0.001, and 2.69 (1.90-4.29) mg/l vs 4.47 (2.96-5.71) mg/l in HUU, p = 0.001, respectively]. Conclusion: Compared to HUU infants, HEU infants have IgG abnormalities mainly represented by low IgG2 levels, suggesting that despite maternal antiretroviral therapy, the mechanisms of IgG transplacental passage continue to be impaired in women living with HIV. HEU infants also showed a significantly lower level of specific anti-PCP IgG, possibly favouring a high vulnerability to S. pneumoniae infection at an age when protection is mostly depending on maternal IgG.
MeSH term(s)	Enzyme-Linked Immunosorbent Assay ; Female ; HIV Infections/prevention & control ; Humans ; Immunoglobulin G ; Infant ; Mothers
Chemical Substances	Immunoglobulin G
Language	English
Publishing date	2022-04-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2041550-3
ISSN	1471-2334 ; 1471-2334
ISSN (online)	1471-2334
ISSN	1471-2334
DOI	10.1186/s12879-022-07335-0
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Article ; Online: Dynamics of SARS-CoV-2 exposure in Malawian infants between February 2020 and May 2021.

Baroncelli, Silvia / Galluzzo, Clementina Maria / Orlando, Stefano / Mphwere, Robert / Kavalo, Thom / Luhanga, Richard / Amici, Roberta / Floridia, Marco / Andreotti, Mauro / Scarcella, Paola / Marazzi, Maria Cristina / Giuliano, Marina

Journal of clinical virology plus

2022 Volume 2, Issue 4, Page(s) 100110

Abstract: Background: Very limited information is available on SARS-CoV-2 seroprevalence in infants in sub-Saharan countries.: Objective: In this study, we aimed to determine the rate and the temporal evolution of SARS CoV-2 seropositivity in breastfed ... ...

Abstract	Background: Very limited information is available on SARS-CoV-2 seroprevalence in infants in sub-Saharan countries. Objective: In this study, we aimed to determine the rate and the temporal evolution of SARS CoV-2 seropositivity in breastfed Malawian infants. Study design: Blood samples ( Results: The confirmed prevalence of anti-SARS CoV-2 antibodies was 31.0% (95% CI: 23.7%-38.3%) with no significant difference between HIV-exposed and HIV-unexposed infants (29.3% and 37.1% respectively, Conclusions: Our data underline the wide spread of the SARS-CoV-2 infection in the pediatric population in sub-Saharan Africa. Design of more specific serological tests for African samples and improvements in serosurveillance programs are needed for more rigorous monitoring of the dynamics of SARS-CoV-2 infection in Africa.
Language	English
Publishing date	2022-09-16
Publishing country	England
Document type	Journal Article
ISSN	2667-0380
ISSN (online)	2667-0380
DOI	10.1016/j.jcvp.2022.100110
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Article ; Online: HIV-exposed infants with EBV infection have a reduced persistence of the immune response to the HBV vaccine.

Baroncelli, Silvia / Galluzzo, Clementina Maria / Liotta, Giuseppe / Andreotti, Mauro / Orlando, Stefano / Ciccacci, Fausto / Mphwere, Robert / Luhanga, Richard / Sagno, Jean Baptiste / Amici, Roberta / Marazzi, Maria Cristina / Giuliano, Marina

AIDS research and therapy

2021 Volume 18, Issue 1, Page(s) 48

Abstract: Background: In sub-Saharan African countries Epstein Barr virus (EBV) infection occurs in early childhood. We aim to investigate the factors associated with EBV acquisition and the impact of EBV infection on the humoral response to HBV vaccination in ... ...

Abstract	Background: In sub-Saharan African countries Epstein Barr virus (EBV) infection occurs in early childhood. We aim to investigate the factors associated with EBV acquisition and the impact of EBV infection on the humoral response to HBV vaccination in infants born from HIV-positive, antiretroviral-treated mothers in Malawi. Methods: A total of 149 HIV-exposed infants were included in this longitudinal study. EBV anti-VCA IgG were measured using an ELISA assay. The EBV seroconversion was correlated with the maternal viro-immunological conditions, with infant growth and immunological vulnerability, and with the humoral response to the HBV vaccine. Results: No infant was EBV-positive at 6 months (n. 52 tested). More than a third of infants (49/115 or 42.6 %) on study beyond 6 months seroconverted at 12 months. At 24 months, out of 66 tested infants, only 13 remained EBV-uninfected, while 53 (80.3 %) acquired EBV infection, rising the total proportion of EBV seroconversion to 88.7 % (102/115 infants). EBV seroconversion was significantly associated with a low maternal educational status but had no impact on infant growth or vulnerability to infections. Reduced HBsAb levels and accelerated waning of antibodies were associated with early EBV seroconversion. Conclusions: We found a heterogeneous timing of acquisition of EBV with the majority of infants born from HIV + mothers acquiring infection after 6 months. Anti-HBs levels were lower and appeared to wane faster in infants acquiring EBV infection.
MeSH term(s)	Child, Preschool ; Epstein-Barr Virus Infections ; Female ; HIV Infections ; Hepatitis B virus ; Herpesvirus 4, Human ; Humans ; Immunity ; Infant ; Longitudinal Studies ; Vaccines
Chemical Substances	Vaccines
Language	English
Publishing date	2021-08-04
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1742-6405
ISSN (online)	1742-6405
DOI	10.1186/s12981-021-00375-7
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