tetano
Editor, Senior Moderator
J Infect Dis
. 2025 Dec 31:jiaf649.
doi: 10.1093/infdis/jiaf649. Online ahead of print.
Cytomegalovirus DNAemia in Hospitalized Adults With SARS-CoV-2 Infection Requiring Supplemental Oxygen: Virologic and Clinical Characteristics and Association With Outcomes
Michael Boeckh[SUP] 1 2 [/SUP], Hu Xie[SUP] 1 [/SUP], Terry Stevens-Ayers[SUP] 1 [/SUP], Linda Sircy[SUP] 1 [/SUP], Danniel Zamora[SUP] 3 [/SUP], Jason D Goldman[SUP] 2 4 [/SUP], Christopher W Woods[SUP] 5 [/SUP], Renee D Stapleton[SUP] 6 [/SUP], Gordon Rubenfeld[SUP] 7 [/SUP], Andre Kalil[SUP] 8 [/SUP], Keith R Jerome[SUP] 1 9 [/SUP], Sayan Dasgupta[SUP] 1 [/SUP], Ajit P Limaye[SUP] 10 [/SUP]
Affiliations
Background: Cytomegalovirus (CMV) reactivation occurs in the context of coronavirus disease 2019 (COVID-19); however, the viral kinetics, risk factors, and clinical outcomes are poorly defined.
Methods: We examined the association of CMV DNAemia with clinical outcomes among participants of a randomized trial of remdesivir with or without baricitinib (National Institute of Allergy and Infectious Diseases [NIAID], Adaptive COVID-19 Treatment Trial 2 [ACTT-2]). Plasma CMV DNAemia from CMV-seropositive participants with COVID-19 (NIAID ordinal scale [OS] 5, 6, or 7 at entry) were assessed longitudinally by quantitative polymerase chain reaction. Factors associated with CMV DNAemia, and clinical outcomes were analyzed by Cox regression and proportional odds models.
Results: Of 772 trial participants with available samples, 643 (83%) were CMV seropositive. Baseline CMV serostatus was not associated with COVID-19 outcomes. The cumulative incidence of CMV DNAemia among seropositive persons by day 28 was overall 11% (baseline OS 5, 6.3%; OS 6, 16.4%; OS 7, 24.7%), and was associated with older age, baseline OS, male sex, lymphopenia, and systemic corticosteroid use, while remdesivir and baricitinib did not affect risk. CMV DNAemia was associated with a lower probability of improvement by day 29 (adjusted hazard ratio, 0.3 [95% confidence interval, .17-.56]), with a more pronounced delay of recovery with higher CMV viral load. CMV DNAemia was also associated with higher severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and death.
Conclusions: In hospitalized adults with COVID-19 requiring oxygen, CMV viremia occurs within well-defined clinical risks and is independently associated with delayed recovery from illness, higher SARS-CoV-2 viral load, and increased mortality.
Keywords: SARS-CoV-2; cytomegalovirus; recovery; viral shedding; viremia.
. 2025 Dec 31:jiaf649.
doi: 10.1093/infdis/jiaf649. Online ahead of print.
Cytomegalovirus DNAemia in Hospitalized Adults With SARS-CoV-2 Infection Requiring Supplemental Oxygen: Virologic and Clinical Characteristics and Association With Outcomes
Michael Boeckh[SUP] 1 2 [/SUP], Hu Xie[SUP] 1 [/SUP], Terry Stevens-Ayers[SUP] 1 [/SUP], Linda Sircy[SUP] 1 [/SUP], Danniel Zamora[SUP] 3 [/SUP], Jason D Goldman[SUP] 2 4 [/SUP], Christopher W Woods[SUP] 5 [/SUP], Renee D Stapleton[SUP] 6 [/SUP], Gordon Rubenfeld[SUP] 7 [/SUP], Andre Kalil[SUP] 8 [/SUP], Keith R Jerome[SUP] 1 9 [/SUP], Sayan Dasgupta[SUP] 1 [/SUP], Ajit P Limaye[SUP] 10 [/SUP]
Affiliations
- PMID: 41533748
- DOI: 10.1093/infdis/jiaf649
Background: Cytomegalovirus (CMV) reactivation occurs in the context of coronavirus disease 2019 (COVID-19); however, the viral kinetics, risk factors, and clinical outcomes are poorly defined.
Methods: We examined the association of CMV DNAemia with clinical outcomes among participants of a randomized trial of remdesivir with or without baricitinib (National Institute of Allergy and Infectious Diseases [NIAID], Adaptive COVID-19 Treatment Trial 2 [ACTT-2]). Plasma CMV DNAemia from CMV-seropositive participants with COVID-19 (NIAID ordinal scale [OS] 5, 6, or 7 at entry) were assessed longitudinally by quantitative polymerase chain reaction. Factors associated with CMV DNAemia, and clinical outcomes were analyzed by Cox regression and proportional odds models.
Results: Of 772 trial participants with available samples, 643 (83%) were CMV seropositive. Baseline CMV serostatus was not associated with COVID-19 outcomes. The cumulative incidence of CMV DNAemia among seropositive persons by day 28 was overall 11% (baseline OS 5, 6.3%; OS 6, 16.4%; OS 7, 24.7%), and was associated with older age, baseline OS, male sex, lymphopenia, and systemic corticosteroid use, while remdesivir and baricitinib did not affect risk. CMV DNAemia was associated with a lower probability of improvement by day 29 (adjusted hazard ratio, 0.3 [95% confidence interval, .17-.56]), with a more pronounced delay of recovery with higher CMV viral load. CMV DNAemia was also associated with higher severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and death.
Conclusions: In hospitalized adults with COVID-19 requiring oxygen, CMV viremia occurs within well-defined clinical risks and is independently associated with delayed recovery from illness, higher SARS-CoV-2 viral load, and increased mortality.
Keywords: SARS-CoV-2; cytomegalovirus; recovery; viral shedding; viremia.