Cytomegalovirus Viremia as a Risk Factor for Mortality Prior to Antiretroviral Therapy among HIV-Infected Gold Miners in South Africa 英文参考文献.docVIP

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Cytomegalovirus Viremia as a Risk Factor for Mortality Prior to Antiretroviral Therapy among HIV-Infected Gold Miners in South Africa 英文参考文献.doc

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Cytomegalovirus Viremia as a Risk Factor for Mortality Prior to Antiretroviral Therapy among HIV-Infected Gold Miners in South Africa 英文参考文献

CytomegalovirusViremiaasaRiskFactorforMortality PriortoAntiretroviralTherapyamongHIV-InfectedGold MinersinSouthAfrica KatherineFielding1*,AiKoba2,AlisonD.Grant2,SalomeCharalambous3,JohnDay2,3,CedricSpak4¤, AnnaWald4,5,6,7,Meei-LiHuang5,LawrenceCorey4,5,7,GavinJ.Churchyard1,3 1DepartmentofInfectiousDiseaseEpidemiology,LondonSchoolofHygieneandTropicalMedicine,London,UnitedKingdom,2DepartmentofClinicalResearch,London School of Hygiene and Tropical Medicine, London, United Kingdom, 3The Aurum Institute, Johannesburg, South Africa, 4Department of Medicine, University of Washington, Seattle, Washington, United States of America, 5Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America, 6Department of Epidemiology, University of Washington, Seattle, Washington, United States of America, 7Vaccine and Infectious Diseases Division, Fred HutchinsonCancerResearchCenter,Seattle,Washington,UnitedStatesofAmerica Abstract Background: Cytomegalovirus (CMV) viremia has been shown to be an independent risk factor for increased mortality amongHIV-infectedindividualsinthedevelopingworld.WhileCMVinfectionisnearlyubiquitousinresource-poorsettings, fewdataareavailableontheroleofsubclinicalCMVreactivationonHIV. Methods:Usingacohortofmineworkerswithstoredplasmasamples,weinvestigatedtheassociationbetweenCMVDNA concentrationandmortalitypriortoantiretroviraltherapyavailability. Results:Among1341individuals(medianCD4count345cells/ml,70%WHOstage1or2,medianfollow-up0.9years),70 (5.2%)hadCMVviremiaatbaseline;71deathsoccurred.InunivariableanalysisCMVviremiaatbaselinewasassociatedwith athree-foldincreaseinmortality(hazardratio[HR]3.37;95%confidenceintervals[CI]1.60,7.10).AfteradjustmentforCD4 count,WHOstageandHIVviralload(N=429withcompletedata),theassociationwasattenuated(HR2.27;95%CI0.88, 5.83).MortalityincreasedwithhigherCMVviremia($1,000copies/mlvs.noviremia,adjustedHR3.65,95%CI:1.29,10.41). Resultsweresimilarusingtime-updatedCMVviremia. Conclus