Anfumbom KFUTWAH. The Fourth ANRS Yaounde site scien5fic mee5ng. November th 2011

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1 HIV 1/CMV co infection in infants (<18 months) born to HIV positive mothers in Cambodia, Vietnam, Cameroon and Central African Republic: Feasibility of co diagnosis on DBS and possible developments. (ANRS ) Anfumbom KFUTWAH The Fourth ANRS Yaounde site scien5fic mee5ng November th 2011

2 Morbidity/Mortality in HIV/CMV co-infected infants (<18 months) CMV inutero transmission severe Higher rate of disease progression in HIV-1/CMV co-infected infants (Kovacs et al, 1999) Higher percentage of symptomatic CMV infections among HIV-1- infected newborns ((23.1% versus 6.7% among HIV-1-uninfected neonates) (Guibert et al, 2009) High frequency of CMV associated pneumopathies in HIV+ newborn (Goussard P et al, 2010).

3 CMV infection in HIV-exposed infants In utero CMV infection higher in HIV-infected infants (p= ) (Doyle, PID 1996). 93% of infants who had acquired HIV-1 in utero (Slyker et al, AIDS 2009) At birth, 4.3 to 4.5% of CMV infection in HIV-exposed neonates (Kovacs, NEJM 1999). 1.4% since the event of the tritherapies (Guibert, CID, 2009) CMV prevalence higher in HIV-infected neonates and infants:10% versus 2.2% in HIV-1 exposed uninfected neonates (p<0.01) (Guibert et al, CID, 2009)

4 Objectives 1. Implementation of real time DNA PCR in house methods to detect HIV and CMV in infants (<18 months) using DBS. 2. To gather preliminary data in terms of co-diagnosis of HIV-1 and CMV in HIV exposed infants in Cambodia, Vietnam, Cameroon and CAR. Material and Method Materiel: DBS (Pediacam anrs 12140) to detect the DNA of CMV Method: Chelex 100 DNA extraction CMV DNA real time PCR (Necker protocol) HIV DNA real time PCR (Biocentric, Bandol, France)

5 Quality Control HIV samples: Samples of HIV exposed infants from the PediaCam (ANRS 12140) study Plasma RNA extraction by qiagen PCR RNA (Biocentric, Bandol, France) In comparison with DBS extraction chelex Beads PCR DNA Biocentric Results 100% concordance CMV Samples: External quality control for 4 sites organized by the National CMV reference center in Necker 5 quality control samples on DBS Samples tested in Necker before shipment In comparison with DBS extraction chelex Beads PCR in house CNR NECKER (transferred technology to CPC) Results 100% concordance

6 Global Age distribution Number of infants tested per site Age CPC IPHC IPC IPB Total (weeks) n % n % n % n % n % to to to to > Total

7 Age Distributions per site DBS collected at 5me of first screening for HIV (D0 << M18) 1592 ( 4 sites) D0-D3 W6-W8 W9-M18 Cambodia Vietnam Cameroon RCA Age (weeks) D0 M18

8 General trends in the results Site Nb DBS tested HIV+ CMV+ VIH+/CMV+ n % n % n % CPC , ,9 18 4,5 IPHC , ,7 16 4,1 IPC ,0 42 8,8 13 2,7 IPB , ,2 28 8,5 Total , ,7 75 4,7 P<10 5

9 CPC Site Age DBS tested HIV+ CMV+ HIV+/CMV+ (weeks) n % n % n % to to > TOTAL All Sites (9.2%) 282 (17.7%) 75 (4.7%) P<10 5

10 Cambodia: Example of In utero transmissions In utero CMV>HIV 3 of 4 in utero infected neonates were also found CMV+ Age N HIV+ CMV+ HIV+ CMV+ HIV+ CMV- HIV- CMV+ HIV- CMV- D0-D (1.1%) 21 (5,8%) 3 (0,8%) 1 (0,3%) 18 (5%) 339 (93,9%) W6-W (5.9%) 7 (13,7%) 1 (2%) 2 (3,9%) 6 (12%) 42 (82,4%) W8-M (50%) 12 (35,3%) 9 (26,5%) 8 (23,5%) 3 (9%) 14 (41,2%) total (5,4%) 40 (9%) 13 (2,9%) 11 (2,5%) 27 (6,1%) 398 (88,6%) 50% of HIV-infected infants are CMV DNA+ (Kovacs et al, 1999)

11 Conclusions Early Infant co-diagnosis of HIV and CMV implemented in 4 Pasteur Institutes (around <10 /test) Need for regular external quality controls of HIV and CMV on DBS The prevalence of CMV was twice higher than that of HIV in HIV exposed infants Around 50% of HIV-infected infants were CMV+ at the age of 6 months In Cambodia, under PMTCT, IUTr of CMV was 5.8% and 1.1% for HIV: Cameroon? 75% (3/4) of in utero HIV-infected neonates were also CMV+ (p value not significative) Cameroon?

12 Perspectives Difficult to compare sites to each other: (timing of DBS collection, breastfeeding, versus formula feeding, ) Data analysis site by site for publications Possible developments: Quantitative analysis of HIV/CMV RNA/DNA viral loads in ARV-treated infants? Immuno/viro/clinical follow up of HIV/CMV co-infected infants? HIV and ARV in utero exposure and maturation of the Immune System of HIV-exposed versus non-exposed uninfected neonates? Innate and adaptative immune responses to CMV infection?

13 Collaborators Co Principal Inves5gators: Marianne Leruez-Ville/Eric Nerrienet Investigators: Sopheak Ngin : Cambodia Tran Ton: Vietnam Jude A. Kfutwah/ Mathurin Tedjiokem : Cameroon Sandrine Moussa: CAR