The Contribution of Kaposi's Sarcoma-Associated Herpesvirus to Mortality in Hospitalized Human Immunodeficiency Virus-Infected Patients Being Investigated for Tuberculosis in South Africa

Blumenthal, Melissa J, Schutz, Charlotte, Barr, David ORCID: 0000-0002-2922-9381, Locketz, Michael, Marshall, Vickie, Whitby, Denise, Katz, Arieh A, Uldrick, Thomas, Meintjes, Graeme and Schafer, Georgia (2019) The Contribution of Kaposi's Sarcoma-Associated Herpesvirus to Mortality in Hospitalized Human Immunodeficiency Virus-Infected Patients Being Investigated for Tuberculosis in South Africa. JOURNAL OF INFECTIOUS DISEASES, 220 (5). pp. 841-851.

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Official URL: http://dx.doi.org/10.1093/infdis/jiz180

Abstract

<h4>Background</h4>Despite increasing numbers of human immunodeficiency virus (HIV)-infected South Africans receiving antiretroviral therapy (ART), tuberculosis (TB) remains the leading cause of mortality. Approximately 25% of patients treated for TB have microbiologically unconfirmed diagnoses. We assessed whether elevated Kaposi's sarcoma-associated herpesvirus (KSHV) viral load (VL) contributes to mortality in hospitalized HIV-infected patients investigated for TB.<h4>Methods</h4>Six hundred eighty-two HIV-infected patients admitted to Khayelitsha Hospital, South Africa, were recruited, investigated for TB, and followed for 12 weeks. KSHV serostatus, peripheral blood KSHV-VL, and KSHV-associated clinical correlates were evaluated.<h4>Results</h4>Median CD4 count was 62 (range, 0-526) cells/μL; KSHV seropositivity was 30.7% (95% confidence interval [CI], 27%-34%); 5.8% had detectable KSHV-VL (median, 199.1 [range, 13.4-2.2 × 106] copies/106 cells); 22% died. Elevated KSHV-VL was associated with mortality (adjusted odds ratio, 6.5 [95% CI, 1.3-32.4]) in patients without TB or other microbiologically confirmed coinfections (n = 159). Six patients had "possible KSHV-inflammatory cytokine syndrome" (KICS): 5 died, representing significantly worse survival (P < .0001), and 1 patient was diagnosed with KSHV-associated multicentric Castleman disease at autopsy.<h4>Conclusions</h4>Given the association of mortality with elevated KSHV-VL in critically ill HIV-infected patients with suspected but not microbiologically confirmed TB, KSHV-VL and KICS criteria may guide diagnostic and therapeutic evaluation.

Item Type:	Article
Uncontrolled Keywords:	HIV, tuberculosis, Kaposi's sarcoma, Kaposi's sarcoma-associated herpesvirus, MCD, KICS, mortality, epidemiology, South Africa
Depositing User:	Symplectic Admin
Date Deposited:	20 Feb 2020 09:10
Last Modified:	19 Jan 2023 00:08
DOI:	10.1093/infdis/jiz180
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3071394