Prevalence and Clinical Characteristics of CMV co-infection among HIV Infected Individuals in Guinea-Bissau: A Cross Sectional Study
BACKGROUND: Cytomegalovirus (CMV) may cause end-organ diseases (EOD) in severely immunocompromised individuals, and figures as an AIDS defining condition in HIV infected individuals. Evidence from high-income countries suggests that CMV may alter the outcome of HIV infection indirectly as well. The purpose of this study was to describe the CMV prevalence in an HIV infected cohort in the West African country Guinea-Bissau. Furthermore, we sought to evaluate differences in patients’ clinical characteristics associated with their CMV status.
METHODS: Newly diagnosed HIV infected adults at the national hospital in Bissau were invited to participate in this cross sectional study, during June 2015 until December 2015. All enrolled patients were interviewed regarding symptoms of CMV EOD, and a full physical examination was performed, focusing on CMV end-organ manifestations. Blood samples were collected and sent to Denmark for analyses of CMV QuantiFERON response, CMV serology and CMV DNA.
RESULTS: In total, 180 patients were included in this study (68.3% HIV-1, 10.0% HIV-2, 3.3% HIV-1/2 18.3% undetermined) with a median CD4 cell count of 198 cell/μL (IQR 100-404). A 100.0% anti-CMV IgG positivity and a 2.8% anti-CMV IgM positivity were found. A positive CMV QuantiFERON response was found in 85.7% of the patients, and 60.5% of the patients had CMV viremia at time of HIV diagnosis. Both CMV QuantiFERON response and detectable CMV viral load were significantly associated with age and upper gastrointestinal complaints.
CONCLUSIONS: CMV co-infection was found among all enrolled patients in this study, consistent with findings from similar settings. Additionally, CMV viremia was found to be highly prevalent compared to other HIV infected study populations in similar settings. This CMV and HIV co-infected study population had multiple symptoms compatible with CMV EOD and low CD4 cell count at time of HIV diagnosis. However, only few significant differences in clinical characteristics were found in association with the patients’ CMV status. New more accessible diagnostic tools or indicators of CMV EOD are needed, as evaluation on CMV EOD in resource-limited settings currently is difficult, due to the requirement of relatively advanced clinical procedures and laboratory techniques for final diagnosis.