Cytomegalovirus viremia as a risk factor for mortality prior to antiretroviral therapy among HIV-infected gold miners in South Africa |
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Authors: | Fielding Katherine Koba Ai Grant Alison D Charalambous Salome Day John Spak Cedric Wald Anna Huang Meei-Li Corey Lawrence Churchyard Gavin J |
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Institution: | Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom. Katherine.fielding@lshtm.ac.uk |
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Abstract: | BackgroundCytomegalovirus (CMV) viremia has been shown to be an independent risk factor for increased mortality among HIV-infected individuals in the developing world. While CMV infection is nearly ubiquitous in resource-poor settings, few data are available on the role of subclinical CMV reactivation on HIV.MethodsUsing a cohort of mineworkers with stored plasma samples, we investigated the association between CMV DNA concentration and mortality prior to antiretroviral therapy availability.ResultsAmong 1341 individuals (median CD4 count 345 cells/µl, 70% WHO stage 1 or 2, median follow-up 0.9 years), 70 (5.2%) had CMV viremia at baseline; 71 deaths occurred. In univariable analysis CMV viremia at baseline was associated with a three-fold increase in mortality (hazard ratio HR] 3.37; 95% confidence intervals CI] 1.60, 7.10). After adjustment for CD4 count, WHO stage and HIV viral load (N?=?429 with complete data), the association was attenuated (HR 2.27; 95%CI 0.88, 5.83). Mortality increased with higher CMV viremia (≥1,000 copies/ml vs. no viremia, adjusted HR 3.65, 95%CI: 1.29, 10.41). Results were similar using time-updated CMV viremia.ConclusionsHigh copy number, subclinical CMV viremia was an independent risk factor for mortality among male HIV-infected adults in South Africa with relatively early HIV disease. Studies to determine whether anti-CMV therapy to mitigate high copy number viremia would increase lifespan are warranted. |
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