{"doi":"10.1093/cid/ciag354","title":"Cytomegalovirus Viremia Is Associated With Mortality Among Children With HIV Starting Antiretroviral Therapy in Sub-Saharan Africa","abstract":"<jats:title>Abstract</jats:title>\n                  <jats:sec>\n                    <jats:title>Background</jats:title>\n                    <jats:p>Cytomegalovirus (CMV) co-infection is associated with mortality in adults with human immunodeficiency virus (HIV) infection, but whether CMV is associated with mortality in children with HIV remains uncertain.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods</jats:title>\n                    <jats:p>In 498 children (median age 6.3 years, interquartile range 2.3–9.6) enrolled in the ARROW trial (ISRCTN24791884) in Uganda (336/498) and Zimbabwe (162/498) selected using a case-cohort design, CMV was quantified using real-time polymerase chain reaction at initiation of non-nucleotide reverse transcriptase inhibitor-based antiretroviral therapy (ART), 12 weeks post-ART, and 84 weeks post-ART. Associations between baseline CMV viremia and mortality were evaluated using multivariable models, adjusting for baseline HIV RNA, CD4+ percentage, and IL-6 concentrations.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>Baseline CMV viremia was associated with mortality, with relationships differing by country and assay. In Zimbabwe (assay limit of detection 20 copies/mL), 119/162 (73%) children had detectable CMV, and each log10 higher CMV viral load was associated with over 2-fold higher mortality (adjusted hazard ratio [aHR] = 2.74; 95% CI 1.57–4.77). In Uganda (assay limit of detection 120 copies/mL), 89/336 (26%) children had detectable CMV viremia, which was associated with 3-fold higher mortality compared to undetectable CMV (aHR = 3.15; 95% CI 1.11–8.93). In a subset of 48 children with immunophenotyping data, we found no evidence that CMV was associated with immune activation.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>Cytomegalovirus viremia is independently associated with mortality in children with HIV starting ART in sub-Saharan Africa. Future studies should define the underlying mechanisms and evaluate whether suppressing CMV viremia reduces mortality in children with HIV.</jats:p>\n                  </jats:sec>","journal":"Clinical Infectious Diseases","year":2026,"id":626070,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":345426,"name":"Ceri Evans","orcid":"0000-0001-9122-9748","position":1,"is_corresponding":false},{"id":346615,"name":"Kuda Mutasa","orcid":null,"position":2,"is_corresponding":false},{"id":1619409,"name":"Dagmar Alber","orcid":null,"position":3,"is_corresponding":false},{"id":626576,"name":"Moira Spyer","orcid":"0000-0001-9149-6029","position":4,"is_corresponding":false},{"id":415591,"name":"Sandra Rukobo","orcid":"0009-0009-2077-666X","position":5,"is_corresponding":false},{"id":1619410,"name":"Mutsa Bwakura-Dangarembizi","orcid":null,"position":6,"is_corresponding":false},{"id":578514,"name":"Victor Musiime","orcid":"0000-0001-7472-9054","position":7,"is_corresponding":false},{"id":1619411,"name":"Kusum J Nathoo","orcid":null,"position":8,"is_corresponding":false},{"id":231146,"name":"Adeodata Kekitiinwa","orcid":"0000-0001-8240-1796","position":9,"is_corresponding":false},{"id":388628,"name":"Cissy Kityo","orcid":"0000-0002-9286-7052","position":10,"is_corresponding":false},{"id":475685,"name":"Diana M. Gibb","orcid":"0000-0002-9738-5490","position":11,"is_corresponding":false},{"id":80427,"name":"Nigel Klein","orcid":null,"position":12,"is_corresponding":false},{"id":245234,"name":"A. Sarah Walker","orcid":"0000-0002-0412-8509","position":13,"is_corresponding":false},{"id":345432,"name":"Andrew J. Prendergast","orcid":"0000-0001-7904-7992","position":14,"is_corresponding":false},{"id":1619408,"name":"Temitope Fisayo","orcid":"0000-0002-3576-3214","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Cytomegalovirus Viremia Is Associated With Mortality Among Children With HIV Starting Antiretroviral Therapy in Sub-Saharan Africa","abstract":"<jats:title>Abstract</jats:title>\n                  <jats:sec>\n                    <jats:title>Background</jats:title>\n                    <jats:p>Cytomegalovirus (CMV) co-infection is associated with mortality in adults with human immunodeficiency virus (HIV) infection, but whether CMV is associated with mortality in children with HIV remains uncertain.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods</jats:title>\n                    <jats:p>In 498 children (median age 6.3 years, interquartile range 2.3–9.6) enrolled in the ARROW trial (ISRCTN24791884) in Uganda (336/498) and Zimbabwe (162/498) selected using a case-cohort design, CMV was quantified using real-time polymerase chain reaction at initiation of non-nucleotide reverse transcriptase inhibitor-based antiretroviral therapy (ART), 12 weeks post-ART, and 84 weeks post-ART. Associations between baseline CMV viremia and mortality were evaluated using multivariable models, adjusting for baseline HIV RNA, CD4+ percentage, and IL-6 concentrations.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>Baseline CMV viremia was associated with mortality, with relationships differing by country and assay. In Zimbabwe (assay limit of detection 20 copies/mL), 119/162 (73%) children had detectable CMV, and each log10 higher CMV viral load was associated with over 2-fold higher mortality (adjusted hazard ratio [aHR] = 2.74; 95% CI 1.57–4.77). In Uganda (assay limit of detection 120 copies/mL), 89/336 (26%) children had detectable CMV viremia, which was associated with 3-fold higher mortality compared to undetectable CMV (aHR = 3.15; 95% CI 1.11–8.93). In a subset of 48 children with immunophenotyping data, we found no evidence that CMV was associated with immune activation.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>Cytomegalovirus viremia is independently associated with mortality in children with HIV starting ART in sub-Saharan Africa. Future studies should define the underlying mechanisms and evaluate whether suppressing CMV viremia reduces mortality in children with HIV.</jats:p>\n                  </jats:sec>","is_dataset_classified":null,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"42262841","pmcid":null,"openalex_id":"https://openalex.org/W7164040051","authors":[],"funders":[{"funder_name":"Medical Research Council","grant_id":"G1001190","title":null},{"funder_name":"Medical Research Council","grant_id":"G0300400","title":null},{"funder_name":"Wellcome","grant_id":"108065/Z/15/Z","title":null},{"funder_name":"MRC Clinical Trials Unit","grant_id":"MC_UU_00004/03","title":null},{"funder_name":"European Union","grant_id":"","title":null},{"funder_name":"National Institute for Health Research (NIHR)","grant_id":"","title":null},{"funder_name":"ViiV Healthcare","grant_id":"","title":null},{"funder_name":"UK Department for International Development","grant_id":"","title":null},{"funder_name":"GlaxoSmithKline","grant_id":"","title":null}],"total_grants":9,"fwci":7.621,"citation_percentile":0.97489163,"influential_citations":0,"citation_trend":[{"year":2026,"count":1}],"oa_status":"hybrid","license":"cc-by","oa_locations":[{"url":"https://doi.org/10.1093/cid/ciag354","host_type":"journal"},{"url":"https://doi.org/10.1093/cid/ciag354","host_type":"publisher"},{"url":"https://academic.oup.com/cid/advance-article-pdf/doi/10.1093/cid/ciag354/68495185/ciag354.pdf","host_type":"publisher"},{"url":"https://pubmed.ncbi.nlm.nih.gov/42262841","host_type":"repository"}],"fields_of_study":["Cytomegalovirus and herpesvirus research","HIV Research and Treatment","HIV-related health complications and treatments"],"mesh_terms":[],"keywords":["Interquartile range","Viral load","Cytomegalovirus","Hazard ratio","Confidence interval","Betaherpesvirinae","Viral disease","Antiretroviral therapy","Mortality rate","Mortality","Children","HIV","CMV","Sub-Saharan Africa"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-04T12:18:05.389310Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}