Cytomegalovirus Viremia as a Risk Factor for Mortality Prior to Antiretroviral Therapy among HIV-Infected Gold Miners in South Africa
Cytomegalovirus Viremia as a Risk Factor for Mortality Prior to Antiretroviral Therapy among HIV-Infected Gold Miners in South Africa
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DOI：
10.1371/journal.pone.0025571
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发表时间：
2011-10-12
期刊：
影响因子：
3.7
通讯作者：
Churchyard, Gavin J.
中科院分区：
文献类型：
--
作者：
Fielding, Katherine;Koba, Ai;Churchyard, Gavin J.
背景资料：巨细胞病毒（CMV）病毒血症已被证明是发展中国家艾滋病毒感染者死亡率增加的一个独立危险因素。虽然巨细胞病毒感染在资源贫乏的环境中几乎无处不在，但关于亚临床巨细胞病毒再激活对HIV的作用的数据很少。方法：使用储存血浆样本的矿工队列，我们调查了抗逆转录病毒治疗可用性之前巨细胞病毒DNA浓度与死亡率之间的关系。结果：在1341例患者中（中位CD 4计数345个细胞/μ l，70% WHO 1或2期，中位随访时间0.9年），70例（5.2%）在基线时有CMV病毒血症; 71例死亡。在单变量分析中，基线时的CMV病毒血症与死亡率增加三倍相关（风险比[HR] 3.37; 95%置信区间[CI] 1.60，7.10）。校正CD 4计数、WHO分期和HIV病毒载量后（N = 429，数据完整），相关性减弱（HR 2.27; 95% CI 0.88，5.83）。CMV病毒血症越高，死亡率越高（>= 1，000拷贝/ml vs.无病毒血症，校正HR 3.65，95% CI：1.29，10.41）。结果是相似的使用时间更新的CMV病毒血症。结论：高拷贝数，亚临床CMV病毒血症是一个独立的危险因素，在南非男性HIV感染的成年人死亡率相对较早的HIV疾病。研究以确定是否抗CMV治疗，以减轻高拷贝数病毒血症将增加寿命是必要的。
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/mu l, 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.