DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20213061

Human cytomegalovirus infection, viraemia and retinitis among people living with HIV/AIDS in Kano, North-Western Nigeria

Chinagozi P. Edwin, Sadiq Hassan, Philips I. Ebisike, Saudat G. Habib, Taiwo G. Amole, Rasheed A. Bakare

Abstract


Background: Human cytomegalovirus (HCMV) is a leading cause of opportunistic infection in HIV-infected patients. HCMV viraemia is an active infection marker and prelude to end-organ diseases (EODs), such as retinitis. The aim of the study was to assess the burden and associated factors of HCMV infection, viraemia and retinitis among HIV-infected patients in Nigeria.

Methods: Comparative cross-sectional study of 160 HIV-infected adults, comprising 80 participants in each of <100/mm3 and ≥100 cells/mm3 CD4+ cell count groups, who attended HIV clinic at a tertiary hospital located in a major Nigerian city.  A questionnaire was used to collect data from eligible consenting participants and their case files. Sera from all participants were tested for anti-HCMV IgG using ELISA method, and plasma of seropositive participants were subjected to PCR for HCMV viraemia. Participants whose samples were HCMV viraemic were examined for HCMV retinitis using indirect ophthalmoscopy. Data was analyzed using Minitab vs 14.1.1PP.

Results: All 160 participants tested positive for anti-HCMV IgG. HCMV viraemia was 14.4% (23 of 160) generally, but comparatively more among <100 CD4 cells/mm3 group (18.8%; 15 of 80) than in ≥100 cells/mm3 patient group (10%; 8 of 80). Only HCMV viraemic patients in <100 CD4 cells/mm3 group (20%; 3 of 15) were diagnosed with HCMV retinitis. WHO stage was associated with HCMV viraemia (χ2= 7.79, p=0.05) and HCMV retinitis (χ2= 4.60, p=0.03). The only predictor of HCMV retinitis was WHO staging I and II [aOR = 0.04, 95%CI (0.01- 0.52)].  

Conclusions: Evidence of previous and active HCMV infection is prevalent among PLWHA in Nigeria with WHO staging being associated and a predictor of HCMV viraemia and retinitis, respectively.


Keywords


Human cytomegalovirus, Human immunodeficiency virus, Kano, Retinitis, Viraemia

Full Text:

PDF

References


Fowotade A, Nwadike VU. Cytomegalovirus in Immunosuppressed Patients: A Silent and Potential killer. Afr J Clin Exper Microbiol. 2012;13(1):35-40.

Jabs DA. Cytomegalovirus Retinitis and the Acquired Immune Deficiency Syndrome: Bench to Bedside: LXVII Edward Jackson Memorial Lecture. Am J Ophthalmol. 2011;151(2):198-216.

Heiden D, Ford N, Wilson D, Rodriguez WR, Margolis T, Janssens B, et al. Cytomegalovirus retinitis: the neglected disease of the AIDS pandemic. PLoS Med. 2007;4(12):334.

Enan KA, Rennert H, Eragi AM, El Hussein AR, Elkhidir IM. Comparison of Real-time PCR to ELISA for the detection of human cytomegalovirus infection in renal transplant patients in the Sudan. Virol J. 2011;8:222.

Jong MD, Galasso GJ, Gazzard B, Griffiths PD, Jabs DA, Kern ER, et al. Summary of the II International Symposium on Cytomegalovirus. Antiviral Res. 1998;39(3):141-62.

Mehrkhani F, Jam S, Sabzvari D, Fattahi F, Kourorian Z, Alinaghi S, et al. Cytomegalovirus co-infection in patients with human immunodeficiency virus in Iran. Acta Med Iran. 2011;49(8):551-5.

Akinbami AA, Akanmu AS, Adeyemo TA, Wright KO, Dada MO, Dosunmu AO. Cytomegalovirus Antibodies Amongst Immunocompromised (HIV) Patients At Lagos University Teaching Hospital (LUTH) Idi-Araba, Lagos. J Med. 2010;11:151-4.

Akinbami AA, Akanmu AS, Adeyemo TA, Wright KO, Dada MO, Dosunmu AO. Cytomegalovirus antibodies among healthy blood donors at Lagos University Teaching Hospital. S Afr Med J. 2009;99(7):528-30.

Kida IM, Denue BA, Bukar B, Waru BG, Talle MA, Ummate I, et al. Seroprevalence and Risk Factors for Cytomegalovirus among HIV-Infected Patients at University of Maiduguri Teaching Hospital, Nigeria. Open J Immunol 2014;4(2):54-9.

National AIDS/STI Control Programme, Federal Ministry of Health. Technical report 2008 National HIV/Syphilis Seroprevalence Sentinel Survey Among Pregnant Women attending Antenatal clinics in Nigeria. Federal Ministry Health. 2008.

Centers for Disease Control and Prevention. Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. MMWR. 2009;58(4):55-60.

Quinnan GV, Masur H, Rook AH, Armstrong G, Frederick WR, Epstein J, et al. Herpesvirus infections in the acquired immune deficiency syndrome. JAMA. 1984;252(1):72-7.

Fielding K, Koba A, Grant AD, Charalambous S, Day J, Spak C, et al. Cytomegalovirus viremia as a risk factor for mortality prior to antiretroviral therapy among HIV-infected gold miners in South Africa. PLoS One. 2011;6(10):25571.

Nokta MA, Holland F, Gruttola V, Emery VC, Jacobson MA, Griffiths P, et al. Cytomegalovirus (CMV) polymerase chain reaction profiles in individuals with advanced human immunodeficiency virus infection: relationship to CMV disease. J Infect Dis. 2002;185(12):1717-22.

Amari EB, Combescure C, Yerly S, Calmy A, Kaiser L, Hasse B, et al. Clinical relevance of cytomegalovirus viraemia(*,†). HIV Med. 2011;12(7):394-402.

Springer KL, Weinberg A. Cytomegalovirus infection in the era of HAART: fewer reactivations and more immunity. J Antimicrob Chemother. 2004;54(3):582-6.

Ceron D. Cytomegalovirus infection: the point in 2001. HIV Med. 2001;2(4):255-9.

Brantsaeter AB, Petersen M, Jeansson S, Goplen AK, Bruun JN. CMV quantitative PCR in the diagnosis of CMV disease in patients with HIV-infection - a retrospective autopsy based study. BMC Infect Dis. 2007;7:127.

Wohl DA, Zeng D, Stewart P, Glomb N, Alcorn T, Jones S, Handy J, et al. Cytomegalovirus viremia, mortality, and end-organ disease among patients with AIDS receiving potent antiretroviral therapies. J Acquir Immune Defic Syndr. 2005;38(5):538-44.

Akinwale OP, Afilaka B, Gyang VP, Adeleke MA, Adeniyi A, Onwujekwe D, et al. Human Cytomegalovirus infection in Nigerians living with human immunodeficiency virus. Ann Trop Med Public Health. 2013;6:59-64.

Kehide AV, Samaila E, Eni RN. Ocular AIDS: experience at the Guiness Opthalmic Unit Kaduna, Nigeria. Nig J Surg Res. 2005;7(3):305-8.

Omolase CO, Komolafe OO, Ayodeji OO, Omolase BD, Akinwalere AK, Majekodunmi MY. Ocular manifestations in HIV-AIDS patients in a Nigerian Community. S Afr Fam Pract. 2012;54(5):455-8.

Kestelyn P. The epidemiology of CMV retinitis in Africa. Ocul Immunol Inflamm. 1999;7:173-7.

Biswas J, Madhavam HN, George AE, Kumarasany N, Solomon S. Ocular lesions associated with HIV infection in India: a series of 100 consecutive patients evaluated at a referral center. Am J Ophthalmol. 2000;129:9-15.

Ausayakhun S, Watananikorn S, Ittipunkul N, Chaideroon W, Paticulsi. Epidemiology of Ocular Complications of HIV infection in Chiang Mai. J Med Assoc Thai. 2003;86:399-406.

Kuppermann BD, Petty JG, Richman DD, Mathews WC, Fullerton SC, Rickman LS, et al. Correlation between CD4+ counts and prevalence of cytomegalovirus retinitis and human immunodeficiency virus-related noninfectious retinal vasculopathy in patients with acquired immunodeficiency syndrome. Am J Ophthalmol. 1993;115(5):575-82.

Chen V, Chen Y, Li H, Kent K, Baumgartner JC, Machida CA. Herpesviruses in abscesses and cellulitis of endodontic origin. J Endod. 2009;35(2):182-8.

Nirwoth JP, Hall AB, Lewallen S. Prevalence of cytomegalovirus retinitis in Tanzanians with low CD4 levels. Br J Ophthalmol. 2010;95:460-2.

Hamid KM, Onoja AB, Tofa UA, Garba KN. Seroprevalence of Cytomegalovirus among pregnant women attending Murtala Muhammed Specialist Hospital Kano, Nigeria. Afr Health Sci. 2014;14(1):125-30.

Gwarzo DH, Gwarzo AK, Ahmed SG. Seroprevalence of cytomegalovirus antibodies among blood donors in Aminu Kano Teaching Hospital, Kano, Nigeria. Niger J Basic Clin Sci. 2020;14:8-14.

Cochereau I, Cabanne N, Godinaud P, Niyongabo T, Poste B, Ngayiragije A, et al. AIDS related eye disease in Burundi, Africa. Br J Ophthalmol. 1999;83(3):339-42.

Hodge WG, Boivin JF, Shapiro SH, Lalonde RG, Shah KC, Murphy BD, et al. Laboratory-based risk factors for cytomegalovirus retinitis. Can J Ophthalmol. 2004;39(7):733-45.

Walter EA, Greenberg PD, Gilbert MJ. Reconstitution of cellular immunity against cytomegalovirus in recipients of allogeneic bone marrow by transfer of T-cell clones from the donor. N Engl J Med. 1995;333(16):1038-44.

Sterling TR, Chaisson RE. General Clinical Manifestations of Human Immunodeficiency Virus Infection (Including the Acute Retroviral Syndrome and Oral Cutaneous, Renal, Ocular, Metabolic and Cardiac Diseases) In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier; 2010: 1705-17025.

Deayton J, Mocroft A, Wilson P, Emery VC, Johnson MA, Griffiths PD. Loss of cytomegalovirus (CMV) viraemia following highly active antiretroviral therapy in the absence of specific anti-CMV therapy. AIDS. 1999;13(10):1203-6.