Prevalence, Risk Factors, and Impact on Outcome of Cytomegalovirus Replication in Serum of Cambodian HIV-Infected Patients (2004-2007)

Background: In developing countries, the study of cytomegalovirus (CMV) coinfection in HIV-infected patients remains neglected. Quantitative CMV polymerase chain reaction (PCR) is the gold standard diagnostic tool for analyzing serum CMV replication and for predicting CMV disease. We estimated the prevalence of replicating CMV in sera of newly diagnosed HIV-infected Cambodian patients and examined its impact on mortality. Methods: This cohort study was based on 2 highly active antiretroviral therapy treatment programs in Cambodia between 2004 and 2007. Quantitative CMV PCR was performed on baseline serum samples of 377 HIV-infected patients. Results: The prevalence of serum CMV DNA was 55.2% (150 of 272) in patients with CD4(+) count <100/mm(3). In multivariate analysis, hemoglobin <9 g/dL, CD4(+) count <100/mm(3), and Karnofsky index <50 were independently associated with positive serum CMV DNA at baseline. During a 3-year follow-tip period, CMV viral load >= 3.1 log(10) copies per milliliter was significantly associated with death independently of CD4(+) count, other opportunistic infections, and highly active antiretroviral therapy. Conclusions: As in industrialized countries, serum CMV replication is highly prevalent among HIV-infected Cambodian patients and is associated with increased mortality. This underscores the importance of diagnostic CMV infection by PCR in sera of HIV-infected patients with CD4(+) count <100/mm(3) and treating this opportunistic infection to reduce its associated mortality.