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Review of cytomegalovirus coinfection in HIV-infected individuals in Africa.

Review of cytomegalovirus coinfection in HIV-infected individuals in Africa.
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Grønborg HL, Jespersen S, Hønge BL, Jensen-Fangel S, Wejse C,


Grønborg HL, Jespersen S, Hønge BL, Jensen-Fangel S, Wejse C, (click to view)

Grønborg HL, Jespersen S, Hønge BL, Jensen-Fangel S, Wejse C,

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Reviews in medical virology 2016 Oct 7() doi 10.1002/rmv.1907

Abstract
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.

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