Cytomegalovirus viremia predicts postdischarge mortality in Kenyan HIV-exposed uninfected children
<p><strong>Background</strong></p> Cytomegalovirus (CMV) viremia is associated with mortality in severely ill immunocompetent adults and hospitalized children with HIV (CWH). We measured CMV viremia in HIV-exposed and -unexposed Kenyan children aged 1–59 months discharged fro...
| Hauptverfasser: | , , , |
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| Format: | Journal article |
| Sprache: | English |
| Veröffentlicht: |
Oxford University Press
2023
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| _version_ | 1826309264512122880 |
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| author | Pavlinac, PB Singa, B Huang, M-L Berkley, JA |
| author_facet | Pavlinac, PB Singa, B Huang, M-L Berkley, JA |
| author_sort | Pavlinac, PB |
| collection | OXFORD |
| description | <p><strong>Background</strong></p>
Cytomegalovirus (CMV) viremia is associated with mortality in severely ill immunocompetent adults and hospitalized children with HIV (CWH). We measured CMV viremia in HIV-exposed and -unexposed Kenyan children aged 1–59 months discharged from hospital and determined its relationship with postdischarge mortality.
<p><strong>Methods</strong></p>
CMV DNA levels were measured in plasma from 1024 children (97 of which were HIV exposed uninfected [HEU], and 15 CWH). Poisson and Cox proportional hazards regression models were used to identify correlates of CMV viremia ≥ 1000 IU/mL
and estimate associations with 6-month mortality, respectively.
<p><strong>Results</strong></p>
CMV viremia was detected in 31% of children, with levels ≥ 1000 IU/mL in 5.8%. HIV infection, age < 2 years, breastfeeding, and midupper arm circumference < 12.5 cm were associated with CMV viremia ≥ 1000 IU/mL. Among HEU children, CMV ≥ 1000 IU/mL (hazard ratio [HR] = 32.0; 95% confidence interval [CI], 2.9–354.0; P = .005) and each 1-log increase in CMV viral load (HR = 5.04; 95% CI, 1.7–14.6; P = .003) were associated with increased risk of mortality. CMV viremia was not significantly associated with mortality in HIV-unexposed children.
<p><strong>Conclusions</strong></p>
CMV levels at hospital postdischarge predict increased risk of 6-month mortality in Kenyan HEU children. CMV suppression may be a novel target to reduce mortality in HEU children.
<p><strong>Clinical Trial Registration</strong></p>
NCT02414399. |
| first_indexed | 2024-03-07T07:33:08Z |
| format | Journal article |
| id | oxford-uuid:3c764153-e018-44fa-9d6d-4adad1a0caf8 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:33:08Z |
| publishDate | 2023 |
| publisher | Oxford University Press |
| record_format | dspace |
| spelling | oxford-uuid:3c764153-e018-44fa-9d6d-4adad1a0caf82023-02-15T08:50:29ZCytomegalovirus viremia predicts postdischarge mortality in Kenyan HIV-exposed uninfected childrenJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:3c764153-e018-44fa-9d6d-4adad1a0caf8EnglishSymplectic ElementsOxford University Press2023Pavlinac, PBSinga, BHuang, M-LBerkley, JA<p><strong>Background</strong></p> Cytomegalovirus (CMV) viremia is associated with mortality in severely ill immunocompetent adults and hospitalized children with HIV (CWH). We measured CMV viremia in HIV-exposed and -unexposed Kenyan children aged 1–59 months discharged from hospital and determined its relationship with postdischarge mortality. <p><strong>Methods</strong></p> CMV DNA levels were measured in plasma from 1024 children (97 of which were HIV exposed uninfected [HEU], and 15 CWH). Poisson and Cox proportional hazards regression models were used to identify correlates of CMV viremia ≥ 1000 IU/mL
and estimate associations with 6-month mortality, respectively. <p><strong>Results</strong></p> CMV viremia was detected in 31% of children, with levels ≥ 1000 IU/mL in 5.8%. HIV infection, age < 2 years, breastfeeding, and midupper arm circumference < 12.5 cm were associated with CMV viremia ≥ 1000 IU/mL. Among HEU children, CMV ≥ 1000 IU/mL (hazard ratio [HR] = 32.0; 95% confidence interval [CI], 2.9–354.0; P = .005) and each 1-log increase in CMV viral load (HR = 5.04; 95% CI, 1.7–14.6; P = .003) were associated with increased risk of mortality. CMV viremia was not significantly associated with mortality in HIV-unexposed children. <p><strong>Conclusions</strong></p> CMV levels at hospital postdischarge predict increased risk of 6-month mortality in Kenyan HEU children. CMV suppression may be a novel target to reduce mortality in HEU children. <p><strong>Clinical Trial Registration</strong></p> NCT02414399. |
| spellingShingle | Pavlinac, PB Singa, B Huang, M-L Berkley, JA Cytomegalovirus viremia predicts postdischarge mortality in Kenyan HIV-exposed uninfected children |
| title | Cytomegalovirus viremia predicts postdischarge mortality in Kenyan HIV-exposed uninfected children |
| title_full | Cytomegalovirus viremia predicts postdischarge mortality in Kenyan HIV-exposed uninfected children |
| title_fullStr | Cytomegalovirus viremia predicts postdischarge mortality in Kenyan HIV-exposed uninfected children |
| title_full_unstemmed | Cytomegalovirus viremia predicts postdischarge mortality in Kenyan HIV-exposed uninfected children |
| title_short | Cytomegalovirus viremia predicts postdischarge mortality in Kenyan HIV-exposed uninfected children |
| title_sort | cytomegalovirus viremia predicts postdischarge mortality in kenyan hiv exposed uninfected children |
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