Cytomegalovirus viremia predicts post-discharge mortality in Kenyan HIV-exposed uninfected children
Pavlinac P., Singa B., Huang M-L., Berkley J.
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.