Cytomegalovirus Viremia Predicts Postdischarge Mortality in Kenyan HIV-Exposed Uninfected Children

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 postdischar...

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Published in:The Journal of infectious diseases 2022-11, Vol.226 (9), p.1519-1527
Main 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
Format: Article
Language:English
Subjects:
Adult
Aftercare
Child
Cytomegalovirus - genetics
Cytomegalovirus Infections
Female
HIV Infections
Humans
Kenya
Patient Discharge
Viral Load
Viremia
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Summary: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. 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. 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. 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. NCT02414399.
ISSN:0022-1899
1537-6613
DOI:10.1093/infdis/jiac047