title: Cytomegalovirus viremia in dried blood spots is associated with an increased risk of death in HIV-infected patients: a cohort study from rural Tanzania.
abstract: OBJECTIVE
  The objectives of the study were to assess the utility of dried blood spots (DBS) for the detection of cytomegalovirus (CMV) antibody and viremia in a resource-poor setting, to study the prevalence of CMV antibody and viremia in HIV-infected patients with access to antiretroviral therapy (ART) in Tanzania, and to relate CMV viremia to outcome.
  
  
  METHODS
  DBS were prepared from 168 ART-naïve patients at baseline. Demographic, clinical, and laboratory data were obtained from patient records. CMV antibody was analyzed by chemiluminescent microparticle immunoassay and viremia by quantitative PCR.
  
  
  RESULTS
  All patients were CMV-seropositive. At baseline 38 (22.6%) had detectable CMV viremia and 14 (8.3%) had a CMV viral load ≥ 200 copies/ml. In 135 patients available for follow-up, CMV ≥ 200 copies/ml was an independent risk factor for death with a hazard ratio of 5.0 (95% confidence interval 2.1-11.9) after adjusting for confounders. Symptoms compatible with CMV disease were common with viremia ≥ 200 copies/ml and CD4+ T cell counts <100 cells/mm(3), but confirmatory diagnostic procedures were unavailable.
  
  
  CONCLUSIONS
  DBS are suitable for the detection of CMV antibody and viremia in HIV patients in resource-poor areas. CMV viremia was frequent and associated with an increased risk of death. Improved diagnosis and treatment of CMV may improve the prognosis for HIV-infected patients in developing countries and should be addressed in future studies.
authors.affiliation: Department of Infectious Diseases, Oslo University Hospital, POB 4956 Nydalen, N-0424 Oslo, Norway. arne.brantsater@medisin.uio.no
authors.forename: Arne B
authors.initials: AB
authors.lastname: Brantsæter
authors.forename: Asgeir
authors.initials: A
authors.lastname: Johannessen
authors.forename: Mona
authors.initials: M
authors.lastname: Holberg-Petersen
authors.forename: Leiv
authors.initials: L
authors.lastname: Sandvik
authors.forename: Ezra
authors.initials: E
authors.lastname: Naman
authors.forename: Sokoine L
authors.initials: SL
authors.lastname: Kivuyo
authors.forename: Halvor
authors.initials: H
authors.lastname: Rollag
authors.forename: Johan N
authors.initials: JN
authors.lastname: Bruun
authors.forename: Dag
authors.initials: D
authors.lastname: Kvale
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000276:immunology / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012307:Risk Factors; D012424:Rural Population; D013636:Tanzania / Q000453:epidemiology; D019562:Viral Load; D014766:Viremia / Q000821:virology*; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral