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

• Published in: PloS one 2011-10, Vol.6 (10), p.e25571-e25571
• Main Authors: Fielding, Katherine, Koba, Ai, Grant, Alison D, Charalambous, Salome, Day, John, Spak, Cedric, Wald, Anna, Huang, Meei-Li, Corey, Lawrence, Churchyard, Gavin J
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Activation; Adult; Adults; AIDS; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; Biology; CD4 antigen; CD4 Lymphocyte Count; Cohort Studies; Confidence intervals; Copy number; Cytomegalovirus; Cytomegalovirus - physiology; Cytomegalovirus infections; Cytomegalovirus Infections - complications; Cytomegalovirus Infections - virology; Deoxyribonucleic acid; Developing countries; DNA; Female; Gold; Gold industry; Health aspects; Health risks; Highly active antiretroviral therapy; HIV; HIV infections; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - mortality; HIV Infections - virology; HIV patients; Human immunodeficiency virus; Humans; Infection; Kaplan-Meier Estimate; Life span; Male; Medicine; Middle Aged; Miners; Mining; Mortality; Proportional Hazards Models; Risk Factors; South Africa; Studies; Therapy; Time Factors; Viremia; Viremia - complications; Viremia - virology
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0025571

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