Hello! Today I am going to talk about CMV infection in Africa. CMV infection and related diseases in Africa has been broadly neglected. Autopsy carried out have shown that CMV is a frequent pathogen in Africa.
There are several reasons that CMV has been overlooked:
First, there is the perception that most Africans are universally infected with CMV during childhood, and that maternal reactivation or reinfection during pregnancy is less likely than primary infection to cause severe congenital infection. Due to this perception, they ignore the possible confounding effects of HIV infection, malnutrition, tuberculosis and general higher disease burden as CMV also infects immunocompromised people.
Second, there is an assumption that patients in Africa do not receive immunosuppressive therapy that may cause CMV disease and thus led to thinking that it is common for them to have CMV infection.
The followings are data of CMV infections in African children:
There is an emerging consensus that congenital CMV, along with other congenital and neonatal infections, is an under-appreciated cause of morbidity and mortality in African children. Most African children are infected with CMV early in infancy irrespective of HIV infection or exposure. CMV is also a probable cause of meningitis and gastrointestinal infection in African children, with or without accompanying bacterial infection , but routine diagnosis and treatment is broadly unavailable.
Next are data of CMV and HIV-infected African adults:
CMV end-organ disease was a common complication of HIV infection in industrialised countries, mainly occurring in patients with CD4 T cell counts <50 cells/μL. However, with ART, CMV disease became rare in this setting. Access to ART has been bad in Africa and now it is improving. However, HIV-associated tuberculosis and bacterial pneumonia continue to be leading causes of death.
Data of CMV Retinitis:
It is one of the most common manifestation of CMV. In a systematic review of HIV-infected individuals in in Africa (18 studies, 4325 patients), the prevalence of CMV retinitis was 2.2% significantly lower than in Asia. One reason could be due to difference in CD4 T cell counts on starting ART.
CMV in non-HIV-infected immunosuppressed adults:
CMV may reactivate and cause severe disease after solid organ and bone marrow transplantation. Patients with inflammatory bowel disease (IBD) are also at risk of complications from CMV infection. CMV may play a role in at least certain populations with IBD in Africa where this disease is diagnosed and treated. As healthcare services in Africa improve, and more advanced treatment is offered, the burden of CMV infection and disease is also likely to escalate.
Diagnostic and therapeutic challenges
There are indications that for severely ill patients in South Africa gancivclovir therapy can be life saving, yet up til now there are still no randomised controlled trials of anti-CMV drugs in Africa. One of the reason is because of the high cost of the drugs. Cheaper drugs are being developed but will only become more available to low-income patient group if they demonstrate sufficient impact.
There is a need for greater implementation of diagnostic tests and clinical trials for treatment of different CMV infection. If clinical trials are to be carry out in Africa, they should consider confounding effects of CMV infection.
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