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Cytomegalovirus Viremia Predicts Postdischarge Mortality in Kenyan HIV-Exposed Uninfected Children( )
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...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9624454/ https://www.ncbi.nlm.nih.gov/pubmed/35152295 http://dx.doi.org/10.1093/infdis/jiac047 |
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author | 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 |
author_facet | 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 |
author_sort | Pavlinac, Patricia B |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-9624454 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-96244542022-11-04 Cytomegalovirus Viremia Predicts Postdischarge Mortality in Kenyan HIV-Exposed Uninfected Children( ) 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 J Infect Dis Major Article 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. Oxford University Press 2022-03-11 /pmc/articles/PMC9624454/ /pubmed/35152295 http://dx.doi.org/10.1093/infdis/jiac047 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Major Article 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 Cytomegalovirus Viremia Predicts Postdischarge Mortality in Kenyan HIV-Exposed Uninfected Children( ) |
title | Cytomegalovirus Viremia Predicts Postdischarge Mortality in Kenyan HIV-Exposed Uninfected Children( ) |
title_full | Cytomegalovirus Viremia Predicts Postdischarge Mortality in Kenyan HIV-Exposed Uninfected Children( ) |
title_fullStr | Cytomegalovirus Viremia Predicts Postdischarge Mortality in Kenyan HIV-Exposed Uninfected Children( ) |
title_full_unstemmed | Cytomegalovirus Viremia Predicts Postdischarge Mortality in Kenyan HIV-Exposed Uninfected Children( ) |
title_short | Cytomegalovirus Viremia Predicts Postdischarge Mortality in Kenyan HIV-Exposed Uninfected Children( ) |
title_sort | cytomegalovirus viremia predicts postdischarge mortality in kenyan hiv-exposed uninfected children( ) |
topic | Major Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9624454/ https://www.ncbi.nlm.nih.gov/pubmed/35152295 http://dx.doi.org/10.1093/infdis/jiac047 |
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