Abstract

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

Pavlinac, P. B. Singa, B. Huang, M. L. Shrestha, L. Li, V. Atlas, H. E. Diakhate, M. M. Brander, R. Meshak, L. Bogonko, G. Tickell, K. D. McGrath, C. J. Machuara, I. M. Ounga, D. O. Berkley, J. A. Richardson, B. A. John-Stewart, G. Walson, J. L. Slyker, J.
J Infect Dis. 2022; 2261519-1527

Permanent 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 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 /= 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.