Abstract

Cytomegalovirus viremia predicts post-discharge mortality in Kenyan HIV-exposed uninfected children

Pavlinac P, Singa B, Huang ML, Shrestha L, Li V, Atlas HE, Diakhate MM, Brander R, Meshak L, Bogonko G, Tickell KD, McGrath CJ, Machuara IM, Ounga DO, Berkley J, Richardson BA, John-Stewart G, Walson JL, Slyker J
J Infect Dis. 2022;226

Permenent descriptor
https://doi.org/10.1093/infdis/jiac047


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 post-discharge mortality. METHODS: CMV DNA levels were measured in plasma from 872 HIV-unexposed, 97 HIV-exposed-uninfected (HEU), and 15 CWH aged <5 years. 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 mid-upper arm circumference<12.5cm were associated with CMV viremia >1000 IU/ml. Among HEU children, CMV >1000 IU/ml (HR=32.0 [95%CI=2.9-354.0], p=0.005) and each 1-log increase in CMV viral load (HR=5.04 [95%CI=1.7, 14.6], p=0.003) were associated with increased risk of mortality. CMV viremia was not significantly associated with mortality in HIV-unexposed children. CONCLUSIONS: CMV levels at hospital discharge predict increased risk of 6-month mortality in Kenyan HEU children. CMV suppression may be a novel target to reduce mortality in this high-risk population.