Cytomegalovirus Viremia Predicts Postdischarge Mortality in Kenyan HIV-Exposed Uninfected Children . (11th March 2022)

• Record Type: Journal Article
• Authors: Pavlinac, Patricia B; Singa, Benson; Huang, Meei-Li; Shrestha, Lasata; Li, Vanessa; Atlas, Hannah E; Diakhate, Mame Mareme; Brander, Rebecca; Meshak, Liru; Bogonko, George; Tickell, Kirkby D; McGrath, Christine J; Machuara, Irine M; Ounga, Derrick O; Berkley, James A; Richardson, Barbra A; John-Stewart, Grace; Walson, Judd L; Slyker, Jennifer
• Is Part Of: Journal of infectious diseases. Volume 226:Number 9(2022)
• Page Start: 1519
• Page End: 1527
• Publication Date: 2022-03-11
• Subjects: cytomegalovirus -- HIV-1 -- child mortality -- postdischarge mortality -- azithromycin; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jiac047
• Languages: English
• ISSNs: 0022-1899

Abstract

Abstract: Background: 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. Methods: 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. Results: 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. Conclusions: 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. Clinical Trial Registration: NCT02414399. Abstract : Cytomegalovirus viremia was common in Kenyan children discharged from hospitals and high CMV viremia levels ( > 1000 IU/mL) were associated with 6-month mortality in HIV-exposed uninfected children. CMV suppression may be a novel target to reduce mortality in this high-risk population.