Cytomegalovirus viremia as a risk factor for mortality prior to antiretroviral therapy among HIV-infected gold miners in South Africa.
<h4>Background</h4>Cytomegalovirus (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 subcl...
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Public Library of Science (PLoS)
2011-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0025571&type=printable |
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| author | Katherine Fielding Ai Koba Alison D Grant Salome Charalambous John Day Cedric Spak Anna Wald Meei-Li Huang Lawrence Corey Gavin J Churchyard |
| author_facet | Katherine Fielding Ai Koba Alison D Grant Salome Charalambous John Day Cedric Spak Anna Wald Meei-Li Huang Lawrence Corey Gavin J Churchyard |
| author_sort | Katherine Fielding |
| collection | DOAJ |
| description | <h4>Background</h4>Cytomegalovirus (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.<h4>Methods</h4>Using a cohort of mineworkers with stored plasma samples, we investigated the association between CMV DNA concentration and mortality prior to antiretroviral therapy availability.<h4>Results</h4>Among 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.<h4>Conclusions</h4>High 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. |
| format | Article |
| id | doaj-art-e8753c62cd0e42b5aecb4d1e025119c3 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2011-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-e8753c62cd0e42b5aecb4d1e025119c32025-08-20T03:09:47ZengPublic Library of Science (PLoS)PLoS ONE1932-62032011-01-01610e2557110.1371/journal.pone.0025571Cytomegalovirus viremia as a risk factor for mortality prior to antiretroviral therapy among HIV-infected gold miners in South Africa.Katherine FieldingAi KobaAlison D GrantSalome CharalambousJohn DayCedric SpakAnna WaldMeei-Li HuangLawrence CoreyGavin J Churchyard<h4>Background</h4>Cytomegalovirus (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.<h4>Methods</h4>Using a cohort of mineworkers with stored plasma samples, we investigated the association between CMV DNA concentration and mortality prior to antiretroviral therapy availability.<h4>Results</h4>Among 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.<h4>Conclusions</h4>High 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.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0025571&type=printable |
| spellingShingle | Katherine Fielding Ai Koba Alison D Grant Salome Charalambous John Day Cedric Spak Anna Wald Meei-Li Huang Lawrence Corey Gavin J Churchyard Cytomegalovirus viremia as a risk factor for mortality prior to antiretroviral therapy among HIV-infected gold miners in South Africa. PLoS ONE |
| title | Cytomegalovirus viremia as a risk factor for mortality prior to antiretroviral therapy among HIV-infected gold miners in South Africa. |
| title_full | Cytomegalovirus viremia as a risk factor for mortality prior to antiretroviral therapy among HIV-infected gold miners in South Africa. |
| title_fullStr | Cytomegalovirus viremia as a risk factor for mortality prior to antiretroviral therapy among HIV-infected gold miners in South Africa. |
| title_full_unstemmed | Cytomegalovirus viremia as a risk factor for mortality prior to antiretroviral therapy among HIV-infected gold miners in South Africa. |
| title_short | Cytomegalovirus viremia as a risk factor for mortality prior to antiretroviral therapy among HIV-infected gold miners in South Africa. |
| title_sort | cytomegalovirus viremia as a risk factor for mortality prior to antiretroviral therapy among hiv infected gold miners in south africa |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0025571&type=printable |
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