title: Distribution and determinants of cytomegalovirus induced end organ disease/s among people living with HIV/AIDS in a poor resource setting: observation from India.
abstract: BACKGROUND
  In India, despite well-established anti-retroviral treatment programs, Cytomegalovirus (CMV) infection-related end-organ diseases (EODs) still remain a major concern resulting in exacerbation of morbidity and mortality among HIV/AIDS patients. A prospective study was designed to understand the distribution and prognosis of CMV associated EODs and to determine a standardized cut-off value for serum CMV viral load associated with the development of EODs amongst HIV/AIDS subjects.
  
  
  METHODS
  In a cohort of 400 late-diagnosed HAART naïve HIV/AIDS subjects attending anti-retroviral centers of Kolkata during 2008-2014, the median duration of follow-up was 560 days, and at least 3 visits subsequent to the baseline were mandatory for eligibility. HIV-1 and CMV viral load were estimated by performing Real-Time Polymerase Chain Reactions (PCR).
  
  
  RESULTS
  Among subjects, 40.5% (162/400) had CMV EODs which were more common at lower CD4 counts. Poor prognosis and higher death rate were associated with a low CD4 count and increased HIV-1 and CMV viral loads. Subjects having higher CD4 count responded better to therapy [for CD4 = 60-100: Risk Ratio:RR = 1.48 (95% Confidence Interval: 95%CI = 1.18-1.82) and for CD4 = 30-59: RR = 1.64 (95%CI = 1.18-2.27)]. The cut off value of the serum CMV viral load (expressed as log10DNA/ml serum) associated with the development of EODs and disseminated CMV EODs was determined as 5.4 (p<0.0001) and 6.4 (p<0.0001) respectively. These cut offs were found to have satisfactorily high sensitivity, specificity, positive and negative predictive values.
  
  
  CONCLUSIONS
  Prognosis of CMV EOD was poor as indicated by higher death rates among subjects with lower CD4 count, and specific cut-off values were found to have useful potential for identification and treatment of CMV infected HIV/AIDS patients in due time to avoid CMV EODs among HIV/AIDS subjects. Targeted intervention programs seemed to be required urgently to make these cut-offs operational in order to minimize the burden of CMV EOD in this vulnerable population.
authors: ICMR Virus Unit, Kolkata, ID & BG Hospital, GB4, 57 Dr. SC Banerjee Road Beliaghata, Kolkata 700 010, India.
authors: Avirup
authors: A
authors: Chakraborty
authors: Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
authors: Tanmay
authors: T
authors: Mahapatra
authors: Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
authors: Sanchita
authors: S
authors: Mahapatra
authors: ICMR Virus Unit, Kolkata, ID & BG Hospital, GB4, 57 Dr. SC Banerjee Road Beliaghata, Kolkata 700 010, India.
authors: Sabbir
authors: S
authors: Ansari
authors: Calcutta Medical College and Hospital, Department of general Medicine, Kolkata 700073, India.
authors: Sattik
authors: S
authors: Siddhanta
authors: Calcutta Medical College and Hospital, Department of general Medicine, Kolkata 700073, India.
authors: Siwalik
authors: S
authors: Banerjee
authors: Calcutta Medical College and Hospital, Apex Clinic, Kolkata 700073, India.
authors: Dipanjan
authors: D
authors: Banerjee
authors: Calcutta Medical College and Hospital, Department of general Medicine, Kolkata 700073, India.
authors: Rathindra Nath
authors: RN
authors: Sarkar
authors: School of Tropical Medicine, Department of Virology, Kolkata 700 073, India.
authors: Subhashish Kamal
authors: SK
authors: Guha
authors: ICMR Virus Unit, Kolkata, ID & BG Hospital, GB4, 57 Dr. SC Banerjee Road Beliaghata, Kolkata 700 010, India.
authors: Nilanjan
authors: N
authors: Chakraborty
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016017:Odds Ratio; D009894:Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D019562:Viral Load; D055815:Young Adult