Review of cytomegalovirus coinfection in HIV-infected individuals in Africa

Rev Med Virol. 2017 Jan;27(1). doi: 10.1002/rmv.1907. Epub 2016 Oct 7.


Background: Cytomegalovirus (CMV) infection among HIV-infected individuals may cause end-organ disease, which is an AIDS-defining condition. Evidence from high-income countries suggests that CMV may alter the outcome of HIV infection, other than causing end-organ diseases. We reviewed literature on HIV and CMV coinfection in Africa.

Methods: Systematic review of published studies on HIV and CMV coinfection in Africa using the PubMed database.

Results: High CMV seroprevalence was found throughout Africa, exceeding 90% in most populations. Retinitis, pneumonia, and colitis were the most commonly reported CMV manifestations in HIV-infected individuals. Among patients with pulmonary symptoms, the prevalence of CMV pneumonitis varied from 20% to over 60%, whereas CMV was found in 0% to 14% of patients with gastrointestinal manifestations. Cytomegalovirus retinitis was found in 0% to 2.6% of examined HIV-infected individuals. The diagnostics of CMV end-organ diseases were found complex and difficult to interpret in African settings. Cytomegalovirus viremia was correlated with significantly lower CD4 cell count and increase in activated and apoptosis vulnerable T-lymphocytes. Also, CMV coinfection was found to be associated with increased transmission and progression of HIV infection. Moreover, detectable CMV DNA was an independent predictor of HIV transmission and mortality among HIV-infected individuals.

Conclusions: Cytomegalovirus is highly prevalent in Africa and a common cause of disease manifestations in HIV-infected individuals among all age groups. Cytomegalovirus coinfection in HIV-infected individuals in Africa is associated with increased transmission and mortality of HIV, but it is a neglected area of research.

Keywords: Africa; CMV; HIV; coinfection; mortality; preemptive therapy.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Africa / epidemiology
  • Coinfection / epidemiology*
  • Cytomegalovirus Infections / epidemiology*
  • HIV Infections / complications*
  • HIV Infections / mortality
  • HIV Infections / transmission
  • Humans
  • Prevalence