title: Cytomegalovirus viremia in Thai HIV-infected patients on antiretroviral therapy: prevalence and associated mortality.
abstract: BACKGROUND
  Prevalence and risk factors of cytomegalovirus (CMV) viremia in patients infected with human immunodeficiency virus (HIV) starting antiretroviral therapy (ART) in developing countries are understudied.
  
  
  METHODS
  We measured CMV DNA in stored plasma specimens of 293 Thai HIV patients starting ART at CD4 counts <200 cells/mm(3). We examined Cox proportional hazard ratios (HRs) of 24 months mortality and new AIDS-defining illness (ADI).
  
  
  RESULTS
  Of 293 patients, 159 (54.3%) were male. The median age was 33 years. The median baseline CD4 count was 82 cells/mm(3), and the median HIV-1 RNA was 4.9 log10 copies/mL. In total, 273 (93.2%) patients started potent combination ART, and 20 (6.8%) started dual nucleoside reverse transcriptase inhibitor (NRTI) therapy. CMV DNA was detected in 77 of 293 patients (26.3%) at baseline, and 9 of 199 patients with available specimen (4.5%) after 6 months of ART. The median CMV DNA was 548 copies/mL (interquartile range [IQR], 129-3849) at baseline and 114 copies/mL (IQR, 75-1099) at 6 months. In univariate analysis, death was associated with baseline CDC stage C, hemoglobin <10 g/dL, lower CD4 count, and CMV viremia. In multivariate analysis, only CMV DNA >500 copies/mL was significantly associated with mortality (HR: 7.28; 95% CI, 1.32-40.29, P = .023). CD4 count was the only variable associated with new ADI (HR: 0.70 per 50 CD4 cells increase; 95% CI, .49-.997, P = .048).
  
  
  CONCLUSIONS
  In these Thai patients with advanced HIV disease, CMV viremia was frequent, and CMV DNA >500 copies/mL predicted increased mortality despite ART initiation. This calls for increased attention to screening of active CMV infection in advanced HIV patients in developing countries. Trials assessing preemptive anti-CMV therapy may be warranted.
authors.affiliation: TREAT Asia, amfAR/The Foundation for AIDS Research, Klongtoey, Bangkok 10110, Thailand. nicolasdurier@hotmail.com
authors.forename: Nicolas
authors.initials: N
authors.lastname: Durier
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
authors.forename: Tanakorn
authors.initials: T
authors.lastname: Apornpong
authors.forename: Sasiwimol
authors.initials: S
authors.lastname: Ubolyam
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kerr
authors.forename: Apicha
authors.initials: A
authors.lastname: Mahanontharit
authors.forename: Laurent
authors.initials: L
authors.lastname: Ferradini
authors.forename: Kiat
authors.initials: K
authors.lastname: Ruxrungtham
authors.forename: Anchalee
authors.initials: A
authors.lastname: Avihingsanon
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001769:Blood / Q000821:virology; D018791:CD4 Lymphocyte Count; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000401:mortality*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013785:Thailand / Q000453:epidemiology; D019562:Viral Load; D014766:Viremia / Q000453:epidemiology* / Q000401:mortality*
chemical_list: D044966:Anti-Retroviral Agents; D004279:DNA, Viral
keywords: HIV; antiretroviral therapy (ART); cytomegalovirus (CMV); mortality; viremia