{
  "abstract": "Background: 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.\n\nMethods: 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.\n\nResults: 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.\n\nConclusions: 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.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 15,
  "authors": [
    {
      "name": "Temitope Fisayo",
      "orcid": "0000-0002-3576-3214"
    },
    {
      "name": "Ceri Evans",
      "orcid": "0000-0001-9122-9748"
    },
    {
      "name": "Kuda Mutasa"
    },
    {
      "name": "Dagmar Alber"
    },
    {
      "name": "Moira J Spyer",
      "orcid": "0000-0001-9149-6029"
    },
    {
      "name": "Sandra Rukobo"
    },
    {
      "name": "Mutsa Bwakura-Dangarembizi"
    },
    {
      "name": "Victor Musiime",
      "orcid": "0000-0001-7472-9054"
    },
    {
      "name": "Kusum J Nathoo"
    },
    {
      "name": "Ade Kekitiinwa",
      "orcid": "0000-0001-8240-1796"
    },
    {
      "name": "Cissy Kityo",
      "orcid": "0000-0002-9286-7052"
    },
    {
      "name": "Diana M Gibb",
      "orcid": "0000-0002-9738-5490"
    },
    {
      "name": "Nigel Klein"
    },
    {
      "name": "A Sarah Walker",
      "orcid": "0000-0002-0412-8509"
    },
    {
      "name": "Andrew J Prendergast",
      "orcid": "0000-0001-7904-7992"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4rf01dmam20gv.bib",
  "cited_by": 1,
  "doi": "10.1093/cid/ciag354",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13715984/",
  "id": "4rf01dmam20gv",
  "issns": [
    "1058-4838",
    "1537-6591"
  ],
  "landing_url": "https://doi.org/10.1093/cid/ciag354",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "AcademicSubjects/MED00290"
    ],
    [
      "heading",
      "Editor's Choice"
    ],
    [
      "heading",
      "HIV/AIDs"
    ],
    [
      "heading",
      "Major Article"
    ],
    [
      "openalex",
      "2713|Cytomegalovirus and herpesvirus research"
    ]
  ],
  "openalex": "W7164040051",
  "pdf_url": null,
  "pmcid": "PMC13715984",
  "pmid": "42262841",
  "published": "2026-06-09",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/4rf01dmam20gv.ris",
  "sources": [
    {
      "first_seen": "2026-11-01T12:23:09Z",
      "native_id": "PMC13715984",
      "source": "pmc",
      "url": "https://doi.org/10.1093/cid/ciag354"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Cytomegalovirus and herpesvirus research",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Cytomegalovirus Viremia Is Associated With Mortality Among Children With HIV Starting Antiretroviral Therapy in Sub-Saharan Africa",
  "title_text": "Cytomegalovirus Viremia Is Associated With Mortality Among Children With HIV Starting Antiretroviral Therapy in Sub-Saharan Africa",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:23:09Z",
  "url": "https://research.draconitic.com/paper/4rf01dmam20gv",
  "venue": "Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America",
  "versions": []
}