Clinical and virologic manifestations of primary Epstein-Barr virus (EBV) infection in Kenyan infants born to HIV-infected women.
ABSTRACT Background. HIV infection is a risk factor for Epstein-Barr virus (EBV)-associated lymphomas. Characterizing primary infection may elucidate risk factors for malignancy.Methods. To describe clinical and virologic manifestations of primary EBV infection among infants born to HIV-infected women. Specimens were utilized from a cohort study conducted in Nairobi, Kenya. HIV-1 and EBV viral load were measured serially in plasma. EBV serology was performed on EBV DNA-negative infants. Monthly clinical examinations were performed by pediatricians.Results. The probability of EBV infection by 1 year of age was 0.78 (95%CI:0.67-0.88) in HIV-infected and 0.49 (95%CI:0.35-0.65) in HIV-uninfected infants (p<0.0001). At 2 years, probability of EBV infection was 0.96 (95%CI:0.89-0.99) in HIV-infected infants. Peak EBV loads were higher in HIV-infected versus HIV-uninfected infants (median 2.6 versus 2.1 log10copies/ml; p<0.0001). The majority of HIV-infected infants had detectable EBV DNA for >3 months (79%). Primary EBV infection was associated with cough, fever, otitis media, pneumonia, hepatomegaly, splenomegaly, and hospitalization in HIV-1 infected infants, and conjunctivitis and rhinorrhea in HIV-uninfected infants.Conclusions. EBV infection occurs early in infants born to HIV-infected women. HIV infection was associated with more frequent and higher quantity EBV DNA detection. Primary EBV may manifest as severe disease in HIV-infected infants.
- The Journal of Infectious Diseases 03/2013; 207. DOI:10.1093/infdis/jit096 · 5.78 Impact Factor
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ABSTRACT: We compared primary Epstein-Barr virus (EBV) infection and suppression between Kenyan HIV-infected infants starting nevirapine- versus lopinavir/ritonavir-based antiretroviral regimens. Although the rate of EBV infection was similar between groups, infants receiving lopinavir/ritonavir suppressed EBV more rapidly. Our findings suggest specific antiretrovirals may potentially impact the risk of future EBV-associated malignancies.Clinical Infectious Diseases 02/2014; DOI:10.1093/cid/ciu088 · 9.42 Impact Factor
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ABSTRACT: Background. Epstein-Barr Virus (EBV) is involved in a wide range of malignancies, particularly in immunocompromised subjects. In Africa, EBV primary infection occurs during early childhood, but little is known about EBV load in HIV-1-infected children.Methods. Dried Blood Spot samples from 213 HIV-1-infected children, 140 on antiretroviral therapy (ART), were collected at the Nsambya Hospital in Kampala, Uganda. Nucleic acids were extracted and analysed for quantification of EBV types 1 and 2, 16S ribosomal DNA (16S rDNA), a marker of microbial translocation, and HIV-1 RNA.Results. Ninety-two of 140(66%) children on ART and 57 of 73(78%) ART-naive children had detectable EBV-DNA levels. Co-infection with both EBV types was less frequent in ART-treated than in ART-naive children (OR=0.54[95%CI 0.30-0.98];P= .042). EBV-DNA levels were lower in the former (3.99±0.59 vs 4.22±0.54 log10 copies/ml;P= .006) and tended to be inversely associated with time on ART. EBV-DNA levels were higher in children with HIV-1 RNA>3 log10 copies/ml of blood (regression coefficient=0.32[95%CI 0.05-0.59];P= .020) and correlated with circulating 16S rDNA levels(rs=0.25[95%CI 0.02-0.46];P= .031).Conclusions. These findings suggest that ART, by limiting HIV-1 replication, microbial translocation and related immune activation, prevents super-infection with both EBV types and keeps EBV viremia down, thus potentially reducing the risk of EBV-associated lymphomas.The Journal of Infectious Diseases 02/2014; 210(3). DOI:10.1093/infdis/jiu099 · 5.78 Impact Factor