Cytomegalovirus viremia as a risk factor for mortality in HIV-associated cryptococcal and tuberculous meningitis.
| Autor: | Skipper CP; University of Minnesota Medical School, Minneapolis, USA; Infectious Diseases Institute, Makerere University, Kampala, Uganda. Electronic address: skipp015@umn.edu., Hullsiek KH; University of Minnesota Division of Biostatistics, Minneapolis, USA., Cresswell FV; Infectious Diseases Institute, Makerere University, Kampala, Uganda; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK., Tadeo KK; Infectious Diseases Institute, Makerere University, Kampala, Uganda., Okirwoth M; Infectious Diseases Institute, Makerere University, Kampala, Uganda., Blackstad M; University of Minnesota Medical School, Minneapolis, USA., Hernandez-Alvarado N; University of Minnesota Medical School, Minneapolis, USA., Fernández-Alarcón C; University of Minnesota Medical School, Minneapolis, USA., Walukaga S; University of Minnesota Medical School, Minneapolis, USA., Martyn E; Infectious Diseases Institute, Makerere University, Kampala, Uganda; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK., Ellis J; Infectious Diseases Institute, Makerere University, Kampala, Uganda; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK., Ssebambulidde K; Infectious Diseases Institute, Makerere University, Kampala, Uganda., Tugume L; Infectious Diseases Institute, Makerere University, Kampala, Uganda., Nuwagira E; Infectious Diseases Institute, Makerere University, Kampala, Uganda; Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda., Rhein J; University of Minnesota Medical School, Minneapolis, USA., Meya DB; University of Minnesota Medical School, Minneapolis, USA; Infectious Diseases Institute, Makerere University, Kampala, Uganda., Boulware DR; University of Minnesota Medical School, Minneapolis, USA., Schleiss MR; University of Minnesota Medical School, Minneapolis, USA. |
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| Jazyk: | angličtina |
| Zdroj: | International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases [Int J Infect Dis] 2022 Sep; Vol. 122, pp. 785-792. Date of Electronic Publication: 2022 Jul 16. |
| DOI: | 10.1016/j.ijid.2022.07.035 |
| Abstrakt: | 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 log Conclusion: CMV viremia at baseline was associated with a higher risk of death at 18 weeks among persons with HIV-associated cryptococcal or TB meningitis, and the risk increased as the CMV viral load increased. Further investigation is warranted to determine whether CMV is a modifiable risk contributing to deaths in HIV-associated meningitis or is a biomarker of immune dysfunction. (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.) |
| Databáze: | MEDLINE |
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