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...

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Asıl Yazarlar: Pavlinac, PB, Singa, B, Huang, M-L, Berkley, JA
Materyal Türü: Journal article
Dil:English
Baskı/Yayın Bilgisi: Oxford University Press 2023
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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.
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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
work_keys_str_mv AT pavlinacpb cytomegalovirusviremiapredictspostdischargemortalityinkenyanhivexposeduninfectedchildren
AT singab cytomegalovirusviremiapredictspostdischargemortalityinkenyanhivexposeduninfectedchildren
AT huangml cytomegalovirusviremiapredictspostdischargemortalityinkenyanhivexposeduninfectedchildren
AT berkleyja cytomegalovirusviremiapredictspostdischargemortalityinkenyanhivexposeduninfectedchildren