Cytomegalovirus viral load kinetics in patients with HIV/AIDS admitted to a medical intensive care unit : a case for pre-emptive therapy
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Date
Authors
Mayaphi, Simnikiwe Horatious
Brauer, Marieke
Morobadi, Daniel M.
Mazanderani, Ahmad Haeri
Mafuyeka, Rendani T.
Olorunju, Steve A.S.
Tintinger, Gregory Ronald
Stoltz, Anton Carel
Journal Title
Journal ISSN
Volume Title
Publisher
Public Library of Science
Abstract
BACKGROUND : Cytomegalovirus (CMV) infection is associated with severe diseases in immunosuppressed patients; however,
there is a lack of data for pre-emptive therapy in patients with HIV/AIDS.
METHOD : This was a retrospective study, which enrolled patients diagnosed with HIV/AIDS (CD4,200 cells/ml), who had
detectable CMV viral load (VL) during their stay in an adult medical intensive care unit between 2009–2012.
RESULTS : After screening 82 patients’ records, 41 patients met the enrolment criteria. Their median age was 37 (interquartile
range [IQR]: 31–46), and median CD4 count was 29 cells/ml (IQR: 5–55). Sixteen patients (39%) had serial measurements of
CMV VL before treatment with ganciclovir. Patients whose baseline CMV VL values were between 1,000–3,000 copies/ml
had significantly higher values (median of 14,650 copies/ml) on follow-up testing done 4–12 days later. Those with
undetectable VLs at baseline testing had detectable VLs (median of 1,590 copies/ml) mostly within 20 days of follow-up
testing. Patients who had VLs .1,000 copies/ml at baseline testing had significantly higher mortality compared to those
who had ,1,000 copies/ml {hazard ratio of 3.46, p = 0.003 [95% confidence interval (CI): 1.55–7.71]}. Analysis of the highest
CMV VL per patient showed that patients who had VLs of .5,100 copies/ml and did not receive ganciclovir had 100%
mortality compared to 58% mortality in those who received ganciclovir at VLs of .5,100 copies/ml, 50% mortality in those
who were not treated and had low VLs of ,5,100 copies/ml, and 44% mortality in those who had ganciclovir treatment at
VLs of ,5,100 copies/ml (p = 0.084, 0.046, 0.037, respectively).
CONCLUSION : This study showed a significantly increased mortality in patients with HIV/AIDS who had high CMV VLs, and
suggests that a threshold value of 1,000 copies/ml may be appropriate for pre-emptive treatment in this group.
Description
Keywords
Therapy, HIV/AIDS, Human immunodeficiency virus (HIV), Acquired immune deficiency syndrome (AIDS), Cytomegalovirus (CMV), CMV viral load (VL), Immunosuppressed patients
Sustainable Development Goals
Citation
Mayaphi SH, Brauer M, Morobadi DM, Mazanderani AH, Mafuyeka RT, et al. (2014) Cytomegalovirus Viral Load Kinetics in Patients with HIV/AIDS Admitted to a Medical Intensive Care Unit: A Case for Pre-Emptive Therapy. PLoS ONE 9(4): e93702. DOI:10.1371/journal.pone.0093702.