Burden of HIV-related CMV retinitis in resource-limited settings: A systematic review

Background. Cytomegalovirus (CMV) is a late stage opportunistic infection in people living with HIV/AIDS. Lack of ophthalmological diagnostic skills or convenient CMV treatment and increasing access to antiretroviral therapy, have all contributed to an assumption that CMV retinitis is no longer a concern in low- and middle-income settings. Methods. We conducted a systematic review and meta-analysis of published and unpublished studies reporting prevalence of CMV retinitis in low- and middle-income countries. Eligible studies assessed the occurrence of CMV retinitis by fundoscopic examination within a cohort of at least 10 HIV-positive adult patients. Results. We identified 65 studies from 24 countries, mainly in Asia (39 studies, 12,931 patients) and Africa (18 studies, 4325 patients). By region, the highest prevalence was observed in Asia with a pooled prevalence of 14.0% (11.8–16.2%). Almost a third (31.6%, 27.6–35.8%) had vision loss in one or both eyes. Few studies reported immune status but, where reported, CD4 count at diagnosis of CMV retinitis was <50 cells/microL in 73.4% of cases. There was no clear pattern of prevalence over time, which was similar for the period 1993-2002 (11.8%, 95%CI 8–15.7%) and 2009–2013 (17.6%, 95%CI 12.6–22.7%). Conclusions. Prevalence of CMV retinitis in resource-limited settings, notably Asian countries, remains high and routine retinal screening of late presenting HIV-positive patients should be considered. HIV programmes must ensure capacity to manage the needs of patients who present late for care.

• Epidemiology and Determinants of Health
  • Epidemiology
• Population(s)
  • General HIV- population
• Engagement and Care Cascade
  • Treatment
• Co-infections
  • Other