title: Burden of HIV-related cytomegalovirus retinitis in resource-limited settings: a systematic review.
abstract: BACKGROUND
  Cytomegalovirus (CMV) is a late-stage opportunistic infection in people living with human immunodeficiency virus (HIV)/AIDS. Lack of ophthalmological diagnostic skills, lack of 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  We conducted a systematic review and meta-analysis of published and unpublished studies reporting prevalence of CMV retinitis in low- and middle-income countries.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 funduscopic 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%, 95% confidence interval [CI], 27.6%-35.8%) had vision loss in 1 or both eyes. Few studies reported immune status, but where reported CD4 count at diagnosis of CMV retinitis was <50 cells/µL 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 low- and middle-income countries, notably Asian countries, remains high, and routine retinal screening of late presenting HIV-positive patients should be considered. HIV programs must ensure capacity to manage the needs of patients who present late for care.
authors.affiliation: Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.forename: Zara
authors.initials: Z
authors.lastname: Shubber
authors.forename: Peter
authors.initials: P
authors.lastname: Saranchuk
authors.forename: Sophia
authors.initials: S
authors.lastname: Pathai
authors.forename: Nicolas
authors.initials: N
authors.lastname: Durier
authors.forename: Daniel P
authors.initials: DP
authors.lastname: O'Brien
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
authors.forename: Fernando
authors.initials: F
authors.lastname: Pascual
authors.forename: Ellen 't
authors.initials: E'
authors.lastname: Hoen
authors.forename: Gary N
authors.initials: GN
authors.lastname: Holland
authors.forename: David
authors.initials: D
authors.lastname: Heiden
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D017726:Cytomegalovirus Retinitis / Q000453:epidemiology*; D003906:Developing Countries; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015995:Prevalence
keywords: HIV; cytomegalovirus; resource-limited settings; retinitis