학술논문
Cytomegalovirus viremia as a risk factor for mortality in HIV-associated cryptococcal and tuberculous meningitis
Document Type
article
Author
Caleb P. Skipper; Katherine Huppler Hullsiek; Fiona V. Cresswell; Kiiza K. Tadeo; Michael Okirwoth; Mark Blackstad; Nelmary Hernandez-Alvarado; Claudia Fernández-Alarcón; Stewart Walukaga; Emily Martyn; Jayne Ellis; Kenneth Ssebambulidde; Lillian Tugume; Edwin Nuwagira; Joshua Rhein; David B. Meya; David R. Boulware; Mark R. Schleiss
Source
International Journal of Infectious Diseases, Vol 122, Iss , Pp 785-792 (2022)
Subject
Language
English
ISSN
1201-9712
Abstract
Objectives: CMV viremia is associated with increased mortality in persons with HIV. We previously demonstrated that CMV viremia was a risk factor for 10-week mortality in antiretroviral therapy (ART)-naïve persons with cryptococcal meningitis. We investigated whether similar observations existed over a broader cohort of patients with HIV-associated meningitis at 18 weeks. Methods: We prospectively enrolled Ugandans with cryptococcal or TB meningitis into clinical trials in 2015-2019. We quantified CMV DNA concentrations from stored baseline plasma or serum samples from 340 participants. We compared 18-week survival between those with and without CMV viremia. Results: We included 308 persons with cryptococcal meningitis and 32 with TB meningitis, of whom 121 (36%) had detectable CMV DNA. Baseline CD4+ T-cell counts (14 vs. 24 cells/µl; P = 0.07) and antiretroviral exposure (47% vs. 45%; P = 0.68) did not differ between persons with and without CMV viremia. The 18-week mortality was 50% (61/121) in those with CMV viremia versus 34% (74/219) in those without (P = 0.003). Detectable CMV viremia (adjusted hazard ratio [aHR] 1.60; 95% confidence interval [CI] 1.13-2.25; P = 0.008) and greater viral load (aHR 1.22 per log10 IU/ml increase; 95% CI 1.09-1.35; P