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 following 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-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, -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, -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 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.