H-2336. A Collective Underestimation In South East Asia: Prevalence, Risk Factors, and Impact on Outcome of CMV Replication in Cambodian HIV-infected Patients (2004-2007)
Session: Poster Session: HIV: Opportunistic Infections, Malignancies, and Other Complications
Monday, October 27, 2008: 12:00 AM
Room: Hall C
Background: In developing countries, opportunistic CMV co-infection in AIDS patients remains neglected. Furthermore, the prevalence of CMV replication in HIV-infected patients from resource-limited countries has not been investigated. Objectives:
To evaluate the prevalence and risk factors of CMV replication in a prospective cohort of 377 newly diagnosed HIV-infected Cambodian patients and its potential impact on outcome. Methods and Findings: Quantitative CMV PCR was performed on baseline serum samples of 377 HIV-infected patients follow-up during 3 years. The prevalence of positive CMV PCR was 55.2% (150/272) in patients with CD4+ counts < 100/mm3. In multivariate analysis, haemoglobin < 9g/dl, CD4+ count < 100/mm3 and Karnofsky index < 50 were independently associated with positive CMV PCR. CMV viral load > 3.6 log10 copies/ml was a risk factor of death (incidence rate ratio=2.4; 95%CI [1.6-3.5]) independently of CD4+ count, cryptococcal infection and HAART. Conclusions: Prevalence of CMV replication is high in severely immunosuppressed HIV-infected Cambodian patients and independently influences the risk of death. CMV co-infection and its impact on mortality might have been largely underestimated in resource-limited countries due to the absence of diagnostic capacity. CMV PCR could help targeting ophtalmological resources and antiviral therapy to high-risk patients in resource-limited areas.
Arnaud Fontanet1, Christine Rouzioux2, Gilles Guerrier1, Hak Chanroeun3, Jean-Philippe Dousset4, Julie Galimand2, Laurrent Ferradini5, Marianne Leruez-Ville2, Olivier Lortholary, MD, PhD6, Philippe Buchy1, Philippe-Jean Guerin7, Romain Micol8, Suna Balkan5, Veasna Duong1 and  R. Micol, None., (1)Institut Pasteur, (2)Hopital Necker-Enfants Malades, (3)Hopital Calmette, (4)MDM, (5)MSF, (6)AP-HP; Univ. Paris V, (7)Epicentre, (8)Institut Pasteur, Paris, France