Prevalence, risk factors, and impact on outcome of cytomegalovirus replication in serum of Cambodian HIV-infected patients (2004-2007).
BACKGROUND
In developing countries, the study of cytomegalovirus (CMV) coinfection in HIV-infected patients remains neglected. Quantitative CMV polymerase chain reaction (PCR) is the gold standard diagnostic tool for analyzing serum CMV replication and for predicting CMV disease. We estimated the prevalence of replicating CMV in sera of newly diagnosed HIV-infected Cambodian patients and examined its impact on mortality.


METHODS
This cohort study was based on 2 highly active antiretroviral therapy treatment programs in Cambodia between 2004 and 2007. Quantitative CMV PCR was performed on baseline serum samples of 377 HIV-infected patients.


RESULTS
The prevalence of serum CMV DNA was 55.2% (150 of 272) in patients with CD4 count <100/mm. In multivariate analysis, hemoglobin <9 g/dL, CD4 count <100/mm, and Karnofsky index <50 were independently associated with positive serum CMV DNA at baseline. During a 3-year follow-up period, CMV viral load >or=3.1 log10 copies per milliliter was significantly associated with death independently of CD4 count, other opportunistic infections, and highly active antiretroviral therapy.


CONCLUSIONS
As in industrialized countries, serum CMV replication is highly prevalent among HIV-infected Cambodian patients and is associated with increased mortality. This underscores the importance of diagnostic CMV infection by PCR in sera of HIV-infected patients with CD4 count <100/mm and treating this opportunistic infection to reduce its associated mortality.
Micol
Romain
R
Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France. romain.micol@gmail.com
Buchy
Philippe
P
Guerrier
Gilles
G
Duong
Veasna
V
Ferradini
Laurent
L
Dousset
Jean-Philippe
JP
Guerin
Philippe J
PJ
Balkan
Suna
S
Galimand
Julie
J
Chanroeun
Hak
H
Lortholary
Olivier
O
Rouzioux
Christine
C
Fontanet
Arnaud
A
Leruez-Ville
Marianne
M
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002160:Cambodia; D003587:Cytomegalovirus / Q000302:isolation & purification*; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000401:mortality / Q000821:virology*; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D014779:Virus Replication
D004279:DNA, Viral