Brief Report: Herpesvirus Viremia, ART Response, and Growth Recovery in Kenyan Children Starting Antiretroviral Therapy in Hospital.

BACKGROUND

We recently reported that cytomegalovirus (CMV) viremia was associated with worse clinical outcomes in hospitalized children starting antiretroviral therapy (ART). Here, we interrogate associations between CMV and Epstein-Barr (EBV) viremia and HIV viral suppression, CD4 recovery, and growth after ART initiation.

SETTING

In-patient setting, 4 hospitals in Kenya.

METHODS

We used regression models to assess associations between CMV and EBV viremia and 6-month growth and immunologic and virologic responses to ART in children aged 2 months to 12 years.

RESULTS

Overall, 142 (78%) of 181 children survived 6 months, of whom 94 (66%) had CMV and EBV DNA assessments pre-ART. Adjusting for baseline HIV RNA, children with baseline plasma CMV DNA ≥1000 IU//mL (coefficient=-5.65; 95% CI: -10.9 to -0.41, P = 0.035) and children with EBV DNA ≥1000 copies/mL had slower rates of CD4% increase (coefficient=-4.66; 95% CI: -7.06 to -2.27, P =<0.001). Age, WHO clinical stage, and stunting predicted growth recovery.

CONCLUSIONS

High CMV or EBV viremia at admission predicted slower CD4 gain over 6 months in infants starting ART. These data suggest that herpesvirus viremia at baseline may identify a subset of children who will have a slower immunologic response to ART. Further research is needed to determine whether herpesvirus viremia delays ART responses and recovery in children.