Ongoing burden of disease and mortality from HIV/CMV coinfection in Africa in the antiretroviral therapy era

Abstract

Human Cytomegalovirus (CMV) is a well-recognized pathogen in the context of HIV infection, but since the roll out of ART, clinical and scientific interest in the problem of HIV/CMV coinfection has diminished. However, CMV remains a significant cofactor in HIV disease, with an influence on HIV acquisition, disease progression, morbidity, and mortality. Disease manifestations may be a result of direct interplay between the two viruses, or may arise as a secondary consequence of immune dysregulation and systemic inflammation. The problem is most relevant when the rates of coinfection are high, most notably in sub-Saharan Africa, and in children at risk of acquiring both infections early in life. Understanding the interplay between these viruses and developing strategies to diagnose, treat and prevent CMV should be a priority.

Beneficial and Detrimental Effects of Antiretroviral Therapy on HIV-Associated Immunosenescence

“…Co-infection with CMV is common among HIV-infected patients and is known to decrease life expectancy [153, 154]. CMV infection is strongly associated with increased terminal differentiation and exhaustion of T cells [22].…”

Elevated cytomegalovirus IgG antibody levels are associated with HIV-1 disease progression and immune activation

“…There is limited data on the role of CMV in chronic HIV disease in sub-Saharan Africa [28-30] . In this region, primary CMV infection predominantly occurs during infancy, and is also associated with the development and maintenance of CD8 + T-cell expansion during childhood [31-33] .…”

Cytomegalovirus Infection of the Gastrointestinal Tract in Soweto, South Africa: A Look Back at the Clinical and Histological Features over 8 Years

“…CMV IHC was performed in a total 31 biopsies (53.5%), was 26/mm 3 (IQR 7-76/mm 3 ) for the 30 patients that were tested. Twenty patients (66.7%) had CD4 counts less than 50/mm 3 and 6 (20%) had CD4 counts > 100/ mm 3 . Thirteen patients (41%) were on antiretroviral therapy, 4 had virological failure and 2 defaulted treatment.…”

“…Three children were diagnosed with CMV infection on tissue biopsy; two were HIV seropositive with CD4 counts of 28/mm 3 and 49/mm 3 . An 11-month-old presented with an acute abdomen secondary to an ileal perforation.…”

“…Three recent reviews on CMV in Africa have noted the paucity of studies on extraocular disease. The need for endoscopically directed biopsies for diagnosis may be a limiting factor [3][4][5]. Fourteen percent of HIV-infected adults with abdominal pain had CMV disease [6].…”