Correlates of change in cytomegalovirus viremia in patients with advanced human immunodeficiency virus infection who require transfusion.
The Viral Activation Transfusion Study compared leukocyte-reduced to unfiltered red blood cell transfusions in human immunodeficiency virus (HIV)- and cytomegalovirus (CMV)-coinfected patients. Relationships between serially measured plasma CMV load and clinical and laboratory outcomes over a median of 12 months were examined in 511 subjects. At baseline, subjects had a median of 15 CD4(+) cells/mm(3), 25% had CMV disease, and 21.5% were viremic. No relationship was found between changes in CMV viremia and changes in HIV RNA. Increased CMV viremia was associated with a concomitant fall in Karnofsky score. Highly active antiretroviral therapy (HAART) led to a decrease in CMV viremia after a 90-day delay. After adjustment for HIV load and CD4(+) cell count, CMV viremia remained associated with an increased risk of CMV disease (relative hazard, 5.78). In late-stage HIV-infected patients, CMV viremia was associated with lower functional status and increased risk of CMV disease. HAART suppressed CMV viremia only after a delay of several months.
Para
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MF
Department of Internal Medicine, Ohio State University, Columbus, OH, USA. para.1@osu.edu
Kalish
L A
LA
Collier
A C
AC
Murphy
E L
EL
Drew
W L
WL
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001804:Blood Transfusion, Autologous; D018791:CD4 Lymphocyte Count; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D004311:Double-Blind Method; D017707:Erythrocyte Transfusion; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000628:therapy / Q000821:virology; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000097:blood; D014766:Viremia / Q000188:drug therapy
D019380:Anti-HIV Agents; D004279:DNA, Viral; D012367:RNA, Viral