There is limited recent information regarding cytomegalovirus (CMV) infection in people living with HIV (PLHIV) and severe immunosuppression. The objectives of this study were to describe the frequencies of CMV DNAemia and CMV target organ disease (CMV-TOD) in this population, their characteristics, and to assess whether high DNAemia levels and CMV-TOD are associated with in-hospital mortality.

Observational, retrospective cohort study conducted at a tertiary hospital in São Paulo. All hospitalized PLHIV over a 12-month period who met the following criteria were included: (i) CD4 count ≤ 100 cells/µL, and (ii) CMV plasma viral load measurement at admission, as per institutional routine. Frequencies of DNAemia (presence of CMV DNA in plasma) and confirmed CMV-TOD were calculated. DNAemia ≥ 10,000 IU/mL was considered high. Chi-square or Fisher’s exact tests were used as appropriate. Factors associated with in-hospital mortality were identified through multivariate logistic regression. The study was approved by the Ethics Committee.

During the study period, 830 PLHIV were hospitalized, and 245 (29.5%) met inclusion criteria. Median (IQR) age was 38 (30–46) years, and 183 (74.7%) were male. Median (IQR) CD4 count was 25 (10–53) cells/µL. Median (IQR) hospital stay was 20 (8–37) days, and 57 (23%) patients died. DNAemia was identified in 150 (61.1%) cases, of which 18 (12%) had high DNAemia. Seventeen (6.9%) patients had CMV-TOD: neurological = 6 and non-neurological = 11 (gastrointestinal tract = 10, retinitis = 3, pneumonitis = 2). Forty-seven (19.1%) patients received preemptive anti-CMV antiviral therapy. Neurological CMV-TOD was associated with high DNAemia (P < 0.001, Fisher’s exact test). Confirmed bacterial infection (OR 7.5, 95% CI 3.4–16.7), antiretroviral use prior to admission (OR 3.8, 95% CI 1.8–8.1), and age ≥ 50 years (OR 3.7, 95% CI 1.6–8.4) were associated with in-hospital mortality.

CMV DNAemia was frequent (∼60%), and CMV-TOD was observed in 7% of cases. One in five patients received preemptive anti-CMV therapy. Neurological CMV-TOD was associated with high DNAemia in exploratory analysis. In contrast to high DNAemia and CMV-TOD, confirmed bacterial infection, prior antiretroviral use, and age ≥ 50 years were independently associated with in-hospital mortality.