Department of Global Health, University of Washington, Seattle, Washington, USA.
Department of Epidemiology, University of Washington, Seattle, Washington, USA.
J Infect Dis. 2022 Nov 1;226(9):1519-1527. doi: 10.1093/infdis/jiac047.
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.
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.
巨细胞病毒（CMV）血症与免疫功能健全的重症成人和伴有 HIV 的住院儿童（CWH）的死亡率相关。我们测定了从医院出院的 1-59 月龄的肯尼亚儿童的 CMV 血症，并确定了其与出院后死亡率的关系。
对 1024 名儿童（其中 97 名是 HIV 暴露但未感染的[HEU]，15 名是 CWH）的血浆进行了 CMV DNA 水平的检测。应用泊松和 Cox 比例风险回归模型来确定 CMV 血症≥1000IU/mL 的相关因素，并分别评估其与 6 个月死亡率的相关性。
31%的儿童检测到 CMV 血症，≥1000IU/mL 的占 5.8%。HIV 感染、年龄<2 岁、母乳喂养和中上臂围<12.5cm 与 CMV 血症≥1000IU/mL 相关。在 HEU 儿童中，CMV≥1000IU/mL（危险比[HR] = 32.0；95%置信区间[CI]，2.9-354.0；P =.005）和每 1 个对数增加的 CMV 病毒载量（HR = 5.04；95% CI，1.7-14.6；P =.003）与死亡率增加相关。CMV 血症与 HIV 未暴露儿童的死亡率无显著相关性。
在肯尼亚的 HEU 儿童中，出院后 CMV 水平可预测 6 个月死亡率的增加风险。CMV 抑制可能是降低 HEU 儿童死亡率的新靶点。
NCT02414399。
