Clinical value of serial quantitative analysis of cytomegalovirus DNA in blood and saliva over the first 24 months of life congenital infection: the French Cymepedia Cohort

International audienceObjective: To evaluate cytomegalovirus (CMV) viral load dynamics in blood and saliva during the first two years of life in symptomatic and asymptomatic infected infants and to identify whether these kinetics could have practical clinical implications.Study design: The Cymepedia cohort prospectively included 256 congenitally infected neonates followed for two years. Whole blood and saliva were collected at inclusion, months 4 and 12, and saliva at months 18 and 24. Real-time CMV PCR was performed, results expressed as log10 IU/mL in blood and in copies/mL in saliva.Results: Viral load in saliva progressively decreased from 7.5 log10 at birth to 3.3 log10 at month 24. CMV PCR in saliva was positive in 100% and 96% of infants at 6 and 12 months, respectively. In the first month of life, neonatal saliva viral load <5 log10 was related to a late CMV transplacental passage. Detection in blood was positive in 92% (147/159) of neonates in the first month of life. No viral load threshold values in blood or saliva could be associated with a high risk of sequelae. Neonatal blood viral load <3 log10 IU/ml had a 100% negative predictive value (NPV) for long-term sequelae.Conclusions: Viral loads in blood and saliva by CMV PCR testing in congenital infection fall over the first 24 months. In this study of infants affected mainly after primary maternal infection during pregnancy, all salivary samples were positive in the first 6 months of life and sequelae were not seen in infants with neonatal blood viral load