Correlates of change in cytomegalovirus viremia in patients with advanced human immunodeficiency virus infection who require transfusion

The Viral Activation Transfusion Study compared leukocyte-reduced to unfilt ered red blood cell transfusions in human immunodeficiency virus (HIV)- and cytomegalovirus (CMV)coinfected patients. Relationships between serially m easured plasma CMV load and clinical and laboratory outcomes over a median of 12 months were examined in 511 subjects. At baseline, subjects had a med ian of 15 CD4(+) cells/mm(3), 25% had CMV disease, and 21.5% were viremic. No relationship was found between changes in CMV viremia and changes in HIV RNA. Increased CMV viremia was associated with a concomitant fall in Karno fsky score. Highly active antiretroviral therapy (HAART) led to a decrease in CMV viremia after a 90-day delay. After adjustment for HIV load and CD4( +) cell count, CMV viremia remained associated with an increased risk of CM V disease (relative hazard, 5.78). In late-stage HIV-infected patients, CMV viremia was associated with lower functional status and increased risk of CMV disease. HAART suppressed CMV viremia only after a delay of several mon ths.