title: Review of cytomegalovirus coinfection in HIV-infected individuals in Africa.
abstract: 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.
  
  
  
  Systematic review of published studies on HIV and CMV coinfection in Africa using the PubMed database.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: GloHAU, Department of Public Health, Global Health, Aarhus University, Aarhus N, Denmark.|Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.|Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
authors.forename: Helene Ladefoged
authors.initials: HL
authors.lastname: Grønborg
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.|Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
authors.forename: Sanne
authors.initials: S
authors.lastname: Jespersen
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.|Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.|Department of Clinical Immunology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Bo Langhoff
authors.initials: BL
authors.lastname: Hønge
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Jensen-Fangel
authors.affiliation: GloHAU, Department of Public Health, Global Health, Aarhus University, Aarhus N, Denmark.|Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.|Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
authors.forename: Christian
authors.identifier: 0000-0002-2534-2942
authors.initials: C
authors.lastname: Wejse
mesh_terms: D000349:Africa / Q000453:epidemiology; D060085:Coinfection / Q000453:epidemiology*; D003586:Cytomegalovirus Infections / Q000453:epidemiology*; D015658:HIV Infections / Q000150:complications* / Q000401:mortality / Q000635:transmission; D006801:Humans; D015995:Prevalence
keywords: Africa; CMV; HIV; coinfection; mortality; preemptive therapy