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

作者：Ford Nathan^*; Shubber Zara; Saranchuk Peter; Pathai Sophia; Durier Nicolas; O' Brien Daniel P; Mills Edward J; Pascual Fernando; ' t Hoen Ellen; Holland Gary N; Heiden David

来源：Clinical Infectious Diseases, 2013, 57(9): 1351-1361.

DOI：10.1093/cid/cit494

• cytomegalovirus
• HIV
• retinitis
• resource-limited settings

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. %26lt;br%26gt;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 We conducted a systematic review and meta-analysis of published and unpublished studies reporting prevalence of CMV retinitis in low-and middle-income countries.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. %26lt;br%26gt;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 %26lt;50 cells/mu L 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%). %26lt;br%26gt;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.

• 出版日期2013-11-1