Cytomegalovirus viremia associated with increased mortality in cryptococcal meningitis in sub-Saharan Africa. Skipper, C., Schleiss, M. R, Bangdiwala, A. S, Hernandez-Alvarado, N., Taseera, K., Nabeta, H. W, Musubire, A. K, Lofgren, S. M, Wiesner, D. L, Rhein, J., Rajasingham, R., Schutz, C., Meintjes, G. A, Muzoora, C., Meya, D. B, & Boulware, D. R Clinical Infectious Diseases, 71(3):525–531, Oxford University Press (OUP), sep, 2020. ![Cytomegalovirus viremia associated with increased mortality in cryptococcal meningitis in sub-Saharan Africa [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex Background Cryptococcal meningitis and tuberculosis are both important causes of death in persons with advanced HIV/AIDS. Cytomegalovirus (CMV) viremia may be associated with increased mortality in HIV-infected persons with tuberculosis. It is unknown if concurrent CMV viremia is associated with mortality in other AIDS-related opportunistic infections. Methods We prospectively enrolled HIV-infected Ugandans with cryptococcal meningitis from 2010–2012. Subsequently, we analyzed stored baseline plasma samples from 111 subjects for CMV DNA. We compared 10-week survival among those with and without CMV viremia. Results Of 111 participants, 52% (58/111) had detectable CMV DNA (median plasma viral load 498 IU/mL; IQR, 259–2390). All samples tested were positive on IgG serology. The median CD4+ T cell count was 19 cells/µL (IQR, 9–70) and did not differ by the presence of CMV viremia (P=.47). The 10-week mortality was 40% (23/58) in those with CMV viremia and 21% (11/53) in those without CMV viremia (Hazard Ratio=2.19; 95%CI, 1.07–4.49; P=.03), which remained significant after multivariate adjustment for known risk factors of mortality (adjusted Hazard Ratio=3.25; 95%CI, 1.49–7.10; P=.003). Serum and CSF cytokine levels were generally similar, and cryptococcal antigen-specific immune stimulation responses did not differ. Conclusion Half of persons with advanced AIDS and cryptococcal meningitis had detectable CMV viremia. CMV viremia was associated with over two-fold higher mortality. It remains unclear whether CMV viremia in severely immunocompromised persons with cryptococcal meningitis contributes directly to this mortality or may reflect underlying immune dysfunction (i.e. cause vs. effect).
@article{Skipper2020,
abstract = {Background Cryptococcal meningitis and tuberculosis are both important causes of death in persons with advanced HIV/AIDS. Cytomegalovirus (CMV) viremia may be associated with increased mortality in HIV-infected persons with tuberculosis. It is unknown if concurrent CMV viremia is associated with mortality in other AIDS-related opportunistic infections. Methods We prospectively enrolled HIV-infected Ugandans with cryptococcal meningitis from 2010–2012. Subsequently, we analyzed stored baseline plasma samples from 111 subjects for CMV DNA. We compared 10-week survival among those with and without CMV viremia. Results Of 111 participants, 52{\%} (58/111) had detectable CMV DNA (median plasma viral load 498 IU/mL; IQR, 259–2390). All samples tested were positive on IgG serology. The median CD4+ T cell count was 19 cells/µL (IQR, 9–70) and did not differ by the presence of CMV viremia (P=.47). The 10-week mortality was 40{\%} (23/58) in those with CMV viremia and 21{\%} (11/53) in those without CMV viremia (Hazard Ratio=2.19; 95{\%}CI, 1.07–4.49; P=.03), which remained significant after multivariate adjustment for known risk factors of mortality (adjusted Hazard Ratio=3.25; 95{\%}CI, 1.49–7.10; P=.003). Serum and CSF cytokine levels were generally similar, and cryptococcal antigen-specific immune stimulation responses did not differ. Conclusion Half of persons with advanced AIDS and cryptococcal meningitis had detectable CMV viremia. CMV viremia was associated with over two-fold higher mortality. It remains unclear whether CMV viremia in severely immunocompromised persons with cryptococcal meningitis contributes directly to this mortality or may reflect underlying immune dysfunction (i.e. cause vs. effect).},
author = {Skipper, Caleb and Schleiss, Mark R and Bangdiwala, Ananta S and Hernandez-Alvarado, Nelmary and Taseera, Kabanda and Nabeta, Henry W and Musubire, Abdu K and Lofgren, Sarah M and Wiesner, Darin L and Rhein, Joshua and Rajasingham, Radha and Schutz, Charlotte and Meintjes, Graeme A and Muzoora, Conrad and Meya, David B and Boulware, David R},
doi = {10.1093/cid/ciz864},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Skipper et al. - 2020 - Cytomegalovirus viremia associated with increased mortality in cryptococcal meningitis in sub-Saharan Africa.pdf:pdf},
issn = {1058-4838},
journal = {Clinical Infectious Diseases},
keywords = {CMV,HIV,cryptococcal meningitis,cryptococcus,cytomegalovirus,fund{\_}not{\_}ack,original},
mendeley-tags = {fund{\_}not{\_}ack,original},
month = {sep},
number = {3},
pages = {525--531},
pmid = {31504335},
publisher = {Oxford University Press (OUP)},
title = {{Cytomegalovirus viremia associated with increased mortality in cryptococcal meningitis in sub-Saharan Africa}},
url = {https://academic.oup.com/cid/article/71/3/525/5557865},
volume = {71},
year = {2020}
}
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Methods We prospectively enrolled HIV-infected Ugandans with cryptococcal meningitis from 2010–2012. Subsequently, we analyzed stored baseline plasma samples from 111 subjects for CMV DNA. We compared 10-week survival among those with and without CMV viremia. Results Of 111 participants, 52% (58/111) had detectable CMV DNA (median plasma viral load 498 IU/mL; IQR, 259–2390). All samples tested were positive on IgG serology. The median CD4+ T cell count was 19 cells/µL (IQR, 9–70) and did not differ by the presence of CMV viremia (P=.47). The 10-week mortality was 40% (23/58) in those with CMV viremia and 21% (11/53) in those without CMV viremia (Hazard Ratio=2.19; 95%CI, 1.07–4.49; P=.03), which remained significant after multivariate adjustment for known risk factors of mortality (adjusted Hazard Ratio=3.25; 95%CI, 1.49–7.10; P=.003). Serum and CSF cytokine levels were generally similar, and cryptococcal antigen-specific immune stimulation responses did not differ. Conclusion Half of persons with advanced AIDS and cryptococcal meningitis had detectable CMV viremia. CMV viremia was associated with over two-fold higher mortality. It remains unclear whether CMV viremia in severely immunocompromised persons with cryptococcal meningitis contributes directly to this mortality or may reflect underlying immune dysfunction (i.e. cause vs. effect).","author":[{"propositions":[],"lastnames":["Skipper"],"firstnames":["Caleb"],"suffixes":[]},{"propositions":[],"lastnames":["Schleiss"],"firstnames":["Mark","R"],"suffixes":[]},{"propositions":[],"lastnames":["Bangdiwala"],"firstnames":["Ananta","S"],"suffixes":[]},{"propositions":[],"lastnames":["Hernandez-Alvarado"],"firstnames":["Nelmary"],"suffixes":[]},{"propositions":[],"lastnames":["Taseera"],"firstnames":["Kabanda"],"suffixes":[]},{"propositions":[],"lastnames":["Nabeta"],"firstnames":["Henry","W"],"suffixes":[]},{"propositions":[],"lastnames":["Musubire"],"firstnames":["Abdu","K"],"suffixes":[]},{"propositions":[],"lastnames":["Lofgren"],"firstnames":["Sarah","M"],"suffixes":[]},{"propositions":[],"lastnames":["Wiesner"],"firstnames":["Darin","L"],"suffixes":[]},{"propositions":[],"lastnames":["Rhein"],"firstnames":["Joshua"],"suffixes":[]},{"propositions":[],"lastnames":["Rajasingham"],"firstnames":["Radha"],"suffixes":[]},{"propositions":[],"lastnames":["Schutz"],"firstnames":["Charlotte"],"suffixes":[]},{"propositions":[],"lastnames":["Meintjes"],"firstnames":["Graeme","A"],"suffixes":[]},{"propositions":[],"lastnames":["Muzoora"],"firstnames":["Conrad"],"suffixes":[]},{"propositions":[],"lastnames":["Meya"],"firstnames":["David","B"],"suffixes":[]},{"propositions":[],"lastnames":["Boulware"],"firstnames":["David","R"],"suffixes":[]}],"doi":"10.1093/cid/ciz864","file":":C$\\$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Skipper et al. - 2020 - Cytomegalovirus viremia associated with increased mortality in cryptococcal meningitis in sub-Saharan Africa.pdf:pdf","issn":"1058-4838","journal":"Clinical Infectious Diseases","keywords":"CMV,HIV,cryptococcal meningitis,cryptococcus,cytomegalovirus,fund_not_ack,original","mendeley-tags":"fund_not_ack,original","month":"sep","number":"3","pages":"525–531","pmid":"31504335","publisher":"Oxford University Press (OUP)","title":"Cytomegalovirus viremia associated with increased mortality in cryptococcal meningitis in sub-Saharan Africa","url":"https://academic.oup.com/cid/article/71/3/525/5557865","volume":"71","year":"2020","bibtex":"@article{Skipper2020,\r\nabstract = {Background Cryptococcal meningitis and tuberculosis are both important causes of death in persons with advanced HIV/AIDS. Cytomegalovirus (CMV) viremia may be associated with increased mortality in HIV-infected persons with tuberculosis. It is unknown if concurrent CMV viremia is associated with mortality in other AIDS-related opportunistic infections. Methods We prospectively enrolled HIV-infected Ugandans with cryptococcal meningitis from 2010–2012. Subsequently, we analyzed stored baseline plasma samples from 111 subjects for CMV DNA. We compared 10-week survival among those with and without CMV viremia. Results Of 111 participants, 52{\\%} (58/111) had detectable CMV DNA (median plasma viral load 498 IU/mL; IQR, 259–2390). All samples tested were positive on IgG serology. The median CD4+ T cell count was 19 cells/µL (IQR, 9–70) and did not differ by the presence of CMV viremia (P=.47). The 10-week mortality was 40{\\%} (23/58) in those with CMV viremia and 21{\\%} (11/53) in those without CMV viremia (Hazard Ratio=2.19; 95{\\%}CI, 1.07–4.49; P=.03), which remained significant after multivariate adjustment for known risk factors of mortality (adjusted Hazard Ratio=3.25; 95{\\%}CI, 1.49–7.10; P=.003). Serum and CSF cytokine levels were generally similar, and cryptococcal antigen-specific immune stimulation responses did not differ. Conclusion Half of persons with advanced AIDS and cryptococcal meningitis had detectable CMV viremia. CMV viremia was associated with over two-fold higher mortality. 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