Burden of HIV-Related Cytomegalovirus Retinitis in Resource-Limited Settings: A Systematic Review

Hdl Handle:
http://hdl.handle.net/10144/303526
Title:
Burden of HIV-Related Cytomegalovirus Retinitis in Resource-Limited Settings: A Systematic Review
Authors:
Ford, Nathan; Shubber, Zara; Saranchuk, Peter; Pathai, Sophia; Durier, Nicolas; O'Brien, Daniel P; Mills, Edward J; Pascual, Fernando; Hoen, Ellen 't; Holland, Gary N; Heiden, David
Journal:
Clinical Infectious Diseases: an official publication of the Infectious Diseases Society of America
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 We conducted a systematic review and meta-analysis of published and unpublished studies reporting prevalence of CMV retinitis in low- and middle-income countries.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.
Affiliation:
Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
Publisher:
Oxford University Press
Issue Date:
2-Sep-2013
URI:
http://hdl.handle.net/10144/303526
DOI:
10.1093/cid/cit494
PubMed ID:
23899681
Additional Links:
http://cid.oxfordjournals.org//cgi/reprint/57/9/1351?ijkey=56xNTA/HM44tA&keytype=ref&siteid=cid
Submitted date:
2013-08-07
Language:
en
Description:
To access this article, click on "Additional Links"
ISSN:
1537-6591
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorFord, Nathanen_GB
dc.contributor.authorShubber, Zaraen_GB
dc.contributor.authorSaranchuk, Peteren_GB
dc.contributor.authorPathai, Sophiaen_GB
dc.contributor.authorDurier, Nicolasen_GB
dc.contributor.authorO'Brien, Daniel Pen_GB
dc.contributor.authorMills, Edward Jen_GB
dc.contributor.authorPascual, Fernandoen_GB
dc.contributor.authorHoen, Ellen 'ten_GB
dc.contributor.authorHolland, Gary Nen_GB
dc.contributor.authorHeiden, Daviden_GB
dc.date.accessioned2013-10-16T20:36:16Z-
dc.date.available2013-10-16T20:36:16Z-
dc.date.issued2013-09-02-
dc.date.submitted2013-08-07-
dc.identifier.citationBurden of HIV-Related Cytomegalovirus Retinitis in Resource-Limited Settings: A Systematic Review. 2013: Clin. Infect. Dis.en_GB
dc.identifier.issn1537-6591-
dc.identifier.pmid23899681-
dc.identifier.doi10.1093/cid/cit494-
dc.identifier.urihttp://hdl.handle.net/10144/303526-
dc.descriptionTo access this article, click on "Additional Links"en_GB
dc.description.abstractBackground. 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.en_GB
dc.languageENG-
dc.language.isoenen
dc.publisherOxford University Pressen_GB
dc.relation.urlhttp://cid.oxfordjournals.org//cgi/reprint/57/9/1351?ijkey=56xNTA/HM44tA&keytype=ref&siteid=ciden_GB
dc.rightsArchived with thanks to Clinical Infectious Diseases: an official publication of the Infectious Diseases Society of America and Oxford University Pressen_GB
dc.subjectHIV/AIDSen_GB
dc.subjectInfections,Viralen_GB
dc.titleBurden of HIV-Related Cytomegalovirus Retinitis in Resource-Limited Settings: A Systematic Reviewen
dc.contributor.departmentDepartment of HIV/AIDS, World Health Organization, Geneva, Switzerland.en_GB
dc.identifier.journalClinical Infectious Diseases: an official publication of the Infectious Diseases Society of Americaen_GB

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