Portal de Periódicos da CAPES

Cytomegalovirus viremia and risk of disease progression and death in HIV-positive patients starting antiretroviral therapy

2022; Lippincott Williams & Wilkins; Linguagem: Inglês

10.1097/qad.0000000000003238

1473-5571

Laura Levi, Shweta Sharma, Mark R. Schleiss, Hansjakob Furrer, Daniel E. Nixon, Mark Blackstad, Nelmary Hernandez-Alvarado, Dominic E. Dwyer, Álvaro H. Borges, H. Clifford Lane, Jens Lundgren, James D. Neaton, Jean‐Michel Molina,

HIV-related health complications and treatments

Objective: To assess the prevalence of CMV viremia in HIV-positive patients starting antiretroviral therapy (ART) and to evaluate its impact on clinical outcomes. Design: Retrospective analysis of four clinical trials (INSIGHT FIRST, SMART, START, and ANRS REFLATE TB). Methods: Stored plasma samples from participants were used to measure CMV viremia at baseline prior to initiating ART and at visits through one year of follow-up after ART initiation. CMV viremia was measured centrally using a quantitative PCR assay. Within FIRST, associations of CMV viremia at baseline and through eight months of ART were examined with a composite clinical outcome of AIDS, serious non-AIDS events, or death using Cox proportional hazards regression. Results: Samples from a total of 3176 participants, 1169 from FIRST, 137 from ANRS REFLATE TB, 54 from SMART, and 1816 from START were available with baseline CMV viremia prevalence of 17%, 26%, 0% and 1%, respectively. Pooled across trials, baseline CMV viremia was associated with low CD4+ T-cell counts and high HIV RNA levels. In FIRST, CMV viremia was detected in only 5% of participants between baseline and month 8. After adjustment for CD4+ T-cell count and HIV RNA levels, hazard ratios (HR) for risk of clinical outcomes was 1.15 (0.86–1.54) and 2.58 (1.68 – 3.98) in FIRST participants with baseline and follow-up CMV viremia, respectively. Conclusion: Baseline CMV viremia in HIV-positive patients starting ART is associated with advanced infection and only persistent CMV viremia after ART initiation is associated with a higher risk of morbidity and mortality.