Cytomegalovirus viremia as a risk factor for mortality prior to antiretroviral therapy among HIV-infected gold miners in South Africa.
BACKGROUND
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.


METHODS
Using a cohort of mineworkers with stored plasma samples, we investigated the association between CMV DNA concentration and mortality prior to antiretroviral therapy availability.


RESULTS
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.


CONCLUSIONS
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.
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom. Katherine.fielding@lshtm.ac.uk
Katherine
K
Fielding
Ai
A
Koba
Alison D
AD
Grant
Salome
S
Charalambous
John
J
Day
Cedric
C
Spak
Anna
A
Wald
Meei-Li
ML
Huang
Lawrence
L
Corey
Gavin J
GJ
Churchyard
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000821:virology*; D005260:Female; D006046:Gold; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality* / Q000821:virology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008906:Mining; D016016:Proportional Hazards Models; D012307:Risk Factors; D013019:South Africa; D013997:Time Factors; D014766:Viremia / Q000150:complications* / Q000821:virology
D006046:Gold