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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Human cytomegalovirus (CMV) in Africa: a neglected but important pathogen</title><author><name sortKey="Bates, Matthew" sort="Bates, Matthew" uniqKey="Bates M" first="Matthew" last="Bates">Matthew Bates</name><affiliation><nlm:aff id="jve5-aff-0001"></nlm:aff></affiliation><affiliation><nlm:aff id="jve5-aff-0002"></nlm:aff></affiliation></author><author><name sortKey="Brantsaeter, Arne Broch" sort="Brantsaeter, Arne Broch" uniqKey="Brantsaeter A" first="Arne Broch" last="Brantsaeter">Arne Broch Brantsaeter</name><affiliation><nlm:aff id="jve5-aff-0003"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27482452</idno><idno type="pmc">4967964</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967964</idno><idno type="RBID">PMC:4967964</idno><date when="????">????</date><idno type="wicri:Area/Pmc/Corpus">000280</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000280</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Human cytomegalovirus (CMV) in Africa: a neglected but important pathogen</title><author><name sortKey="Bates, Matthew" sort="Bates, Matthew" uniqKey="Bates M" first="Matthew" last="Bates">Matthew Bates</name><affiliation><nlm:aff id="jve5-aff-0001"></nlm:aff></affiliation><affiliation><nlm:aff id="jve5-aff-0002"></nlm:aff></affiliation></author><author><name sortKey="Brantsaeter, Arne Broch" sort="Brantsaeter, Arne Broch" uniqKey="Brantsaeter A" first="Arne Broch" last="Brantsaeter">Arne Broch Brantsaeter</name><affiliation><nlm:aff id="jve5-aff-0003"></nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Virus Eradication</title><idno type="ISSN">2055-6640</idno><idno type="eISSN">2055-6659</idno><imprint><date when="????">????</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Abstract</title><p id="jve5-para-0001">In Africa, human cytomegalovirus (CMV) is an important pathogen in a diverse range of patient groups. Congenital CMV infection is common, and most children undergo primary infection during the first year of life. Preliminary studies suggest that these early primary CMV infections could have population-wide effects on growth and development. In most studies of adults, CMV seroprevalence is close to 100%, but some studies have found that significant minorities of adults are seronegative. CMV is a common cause of pneumonia and meningitis in hospitalised immunosuppressed patient groups, and CMV DNAemia may be an important marker of rapid progression and poor outcomes of HIV infection, despite roll-out of antiretroviral therapy (ART). Diagnosis and treatment of CMV-related disease is broadly neglected in Africa, and no randomised clinical trials of anti-CMV drugs have been conducted to date. Autopsy is rarely performed in Africa, but identifies CMV as a frequent pathogen when it is carried out. Here we review the available literature on CMV in Africa, primarily in adult patients, and discuss this in the context of contemporary understanding of CMV as a human pathogen.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Manicklal, S" uniqKey="Manicklal S">S Manicklal</name></author><author><name sortKey="Emery, Vc" uniqKey="Emery V">VC Emery</name></author><author><name sortKey="Lazzarotto, T" uniqKey="Lazzarotto T">T Lazzarotto</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bates, M" uniqKey="Bates M">M Bates</name></author><author><name sortKey="Musonda, K" uniqKey="Musonda K">K Musonda</name></author><author><name sortKey="Zumla, A" uniqKey="Zumla A">A Zumla</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lanzieri, Tm" uniqKey="Lanzieri T">TM Lanzieri</name></author><author><name sortKey="Dollard, Sc" uniqKey="Dollard S">SC Dollard</name></author><author><name sortKey="Bialek, Sr" uniqKey="Bialek S">SR Bialek</name></author><author><name sortKey="Grosse, Sd" uniqKey="Grosse S">SD Grosse</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Goussard, P" uniqKey="Goussard P">P Goussard</name></author><author><name sortKey="Kling, S" uniqKey="Kling S">S Kling</name></author><author><name sortKey="Gie, Rp" uniqKey="Gie R">RP Gie</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hsiao, Ny" uniqKey="Hsiao N">NY Hsiao</name></author><author><name sortKey="Zampoli, M" uniqKey="Zampoli M">M Zampoli</name></author><author><name sortKey="Morrow, B" uniqKey="Morrow B">B Morrow</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zampoli, M" uniqKey="Zampoli M">M Zampoli</name></author><author><name sortKey="Morrow, B" uniqKey="Morrow B">B Morrow</name></author><author><name sortKey="Hsiao, Ny" uniqKey="Hsiao N">NY Hsiao</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tembo, J" uniqKey="Tembo J">J Tembo</name></author><author><name sortKey="Kabwe, M" uniqKey="Kabwe M">M Kabwe</name></author><author><name sortKey="Chilukutu, L" uniqKey="Chilukutu L">L Chilukutu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kelly, Mj" uniqKey="Kelly M">MJ Kelly</name></author><author><name sortKey="Benjamin, La" uniqKey="Benjamin L">LA Benjamin</name></author><author><name sortKey="Cartwright, K" uniqKey="Cartwright K">K Cartwright</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gompels, Ua" uniqKey="Gompels U">UA Gompels</name></author><author><name sortKey="Larke, N" uniqKey="Larke N">N Larke</name></author><author><name sortKey="Sanz Ramos, M" uniqKey="Sanz Ramos M">M Sanz-Ramos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Adland, E" uniqKey="Adland E">E Adland</name></author><author><name sortKey="Klenerman, P" uniqKey="Klenerman P">P Klenerman</name></author><author><name sortKey="Goulder, P" uniqKey="Goulder P">P Goulder</name></author><author><name sortKey="Matthews, Pc" uniqKey="Matthews P">PC Matthews</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mayaphi, Sh" uniqKey="Mayaphi S">SH Mayaphi</name></author><author><name sortKey="Brauer, M" uniqKey="Brauer M">M Brauer</name></author><author><name sortKey="Morobadi, Dm" uniqKey="Morobadi D">DM Morobadi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Foulon, I" uniqKey="Foulon I">I Foulon</name></author><author><name sortKey="Naessens, A" uniqKey="Naessens A">A Naessens</name></author><author><name sortKey="Foulon, W" uniqKey="Foulon W">W Foulon</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fowler, Kb" uniqKey="Fowler K">KB Fowler</name></author><author><name sortKey="Stagno, S" uniqKey="Stagno S">S Stagno</name></author><author><name sortKey="Pass, Rf" uniqKey="Pass R">RF Pass</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ross, Sa" uniqKey="Ross S">SA Ross</name></author><author><name sortKey="Fowler, Kb" uniqKey="Fowler K">KB Fowler</name></author><author><name sortKey="Ashrith, G" uniqKey="Ashrith G">G Ashrith</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vries, Jj" uniqKey="Vries J">JJ Vries</name></author><author><name sortKey="Zwet, Ew" uniqKey="Zwet E">EW Zwet</name></author><author><name sortKey="Dekker, Fw" uniqKey="Dekker F">FW Dekker</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Ajayi, So" uniqKey="Ajayi S">SO Ajayi</name></author><author><name sortKey="Raji, Y" uniqKey="Raji Y">Y Raji</name></author><author><name sortKey="Salako, Bl" uniqKey="Salako B">BL Salako</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Spearman, Cw" uniqKey="Spearman C">CW Spearman</name></author><author><name sortKey="Mcculloch, Mi" uniqKey="Mcculloch M">MI McCulloch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dupont, L" uniqKey="Dupont L">L Dupont</name></author><author><name sortKey="Reeves, Mb" uniqKey="Reeves M">MB Reeves</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mussi Pinhata, Mm" uniqKey="Mussi Pinhata M">MM Mussi-Pinhata</name></author><author><name sortKey="Yamamoto, Ay" uniqKey="Yamamoto A">AY Yamamoto</name></author><author><name sortKey="Moura Brito, Rm" uniqKey="Moura Brito R">RM Moura Brito</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yamamoto, Ay" uniqKey="Yamamoto A">AY Yamamoto</name></author><author><name sortKey="Mussi Pinhata, Mm" uniqKey="Mussi Pinhata M">MM Mussi-Pinhata</name></author><author><name sortKey="Boppana, Sb" uniqKey="Boppana S">SB Boppana</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yamamoto, Ay" uniqKey="Yamamoto A">AY Yamamoto</name></author><author><name sortKey="Mussi Pinhata, Mm" uniqKey="Mussi Pinhata M">MM Mussi-Pinhata</name></author><author><name sortKey="Isaac Mde, L" uniqKey="Isaac Mde L">L Isaac Mde</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Staras, Sa" uniqKey="Staras S">SA Staras</name></author><author><name sortKey="Dollard, Sc" uniqKey="Dollard S">SC Dollard</name></author><author><name sortKey="Radford, Kw" uniqKey="Radford K">KW Radford</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ahlfors, K" uniqKey="Ahlfors K">K Ahlfors</name></author><author><name sortKey="Ivarsson, Sa" uniqKey="Ivarsson S">SA Ivarsson</name></author><author><name sortKey="Johnsson, T" uniqKey="Johnsson T">T Johnsson</name></author><author><name sortKey="Svanberg, L" uniqKey="Svanberg L">L Svanberg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Numazaki, K" uniqKey="Numazaki K">K Numazaki</name></author><author><name sortKey="Fujikawa, T" uniqKey="Fujikawa T">T Fujikawa</name></author><author><name sortKey="Chiba, S" uniqKey="Chiba S">S Chiba</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shigemi, D" uniqKey="Shigemi D">D Shigemi</name></author><author><name sortKey="Yamaguchi, S" uniqKey="Yamaguchi S">S Yamaguchi</name></author><author><name sortKey="Otsuka, T" uniqKey="Otsuka T">T Otsuka</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cannon, Mj" uniqKey="Cannon M">MJ Cannon</name></author><author><name sortKey="Schmid, Ds" uniqKey="Schmid D">DS Schmid</name></author><author><name sortKey="Hyde, Tb" uniqKey="Hyde T">TB Hyde</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Green, Ms" uniqKey="Green M">MS Green</name></author><author><name sortKey="Cohen, D" uniqKey="Cohen D">D Cohen</name></author><author><name sortKey="Slepon, R" uniqKey="Slepon R">R Slepon</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kaur, A" uniqKey="Kaur A">A Kaur</name></author><author><name sortKey="Kassis, N" uniqKey="Kassis N">N Kassis</name></author><author><name sortKey="Hale, Cl" uniqKey="Hale C">CL Hale</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Olaleye, Od" uniqKey="Olaleye O">OD Olaleye</name></author><author><name sortKey="Omilabu, Sa" uniqKey="Omilabu S">SA Omilabu</name></author><author><name sortKey="Baba, Ss" uniqKey="Baba S">SS Baba</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Maiga, Ii" uniqKey="Maiga I">II Maiga</name></author><author><name sortKey="Tounkara, A" uniqKey="Tounkara A">A Tounkara</name></author><author><name sortKey="Coulibaly, G" uniqKey="Coulibaly G">G Coulibaly</name></author><author><name sortKey="Kouriba, B" uniqKey="Kouriba B">B Kouriba</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mhalu, F" uniqKey="Mhalu F">F Mhalu</name></author><author><name sortKey="Haukenes, G" uniqKey="Haukenes G">G Haukenes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Adjei, Aa" uniqKey="Adjei A">AA Adjei</name></author><author><name sortKey="Armah, Hb" uniqKey="Armah H">HB Armah</name></author><author><name sortKey="Gbagbo, F" uniqKey="Gbagbo F">F Gbagbo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ledru, E" uniqKey="Ledru E">E Ledru</name></author><author><name sortKey="Diagbouga, S" uniqKey="Diagbouga S">S Diagbouga</name></author><author><name sortKey="Ledru, S" uniqKey="Ledru S">S Ledru</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Compston, Li" uniqKey="Compston L">LI Compston</name></author><author><name sortKey="Li, C" uniqKey="Li C">C Li</name></author><author><name sortKey="Sarkodie, F" uniqKey="Sarkodie F">F Sarkodie</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ismail, So" uniqKey="Ismail S">SO Ismail</name></author><author><name sortKey="Ahmed, Hj" uniqKey="Ahmed H">HJ Ahmed</name></author><author><name sortKey="Grillner, L" uniqKey="Grillner L">L Grillner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Njeru, Dg" uniqKey="Njeru D">DG Njeru</name></author><author><name sortKey="Mwanda, Wo" uniqKey="Mwanda W">WO Mwanda</name></author><author><name sortKey="Kitonyi, Gw" uniqKey="Kitonyi G">GW Kitonyi</name></author><author><name sortKey="Njagi, Ec" uniqKey="Njagi E">EC Njagi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hannachi, N" uniqKey="Hannachi N">N Hannachi</name></author><author><name sortKey="Boughammoura, L" uniqKey="Boughammoura L">L Boughammoura</name></author><author><name sortKey="Marzouk, M" uniqKey="Marzouk M">M Marzouk</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gargouri, J" uniqKey="Gargouri J">J Gargouri</name></author><author><name sortKey="Elleuch, H" uniqKey="Elleuch H">H Elleuch</name></author><author><name sortKey="Karray, H" uniqKey="Karray H">H Karray</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wester, Cw" uniqKey="Wester C">CW Wester</name></author><author><name sortKey="Bussmann, H" uniqKey="Bussmann H">H Bussmann</name></author><author><name sortKey="Moyo, S" uniqKey="Moyo S">S Moyo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schaftenaar, E" uniqKey="Schaftenaar E">E Schaftenaar</name></author><author><name sortKey="Verjans, Gm" uniqKey="Verjans G">GM Verjans</name></author><author><name sortKey="Getu, S" uniqKey="Getu S">S Getu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brantsaeter, Ab" uniqKey="Brantsaeter A">AB Brantsaeter</name></author><author><name sortKey="Johannessen, A" uniqKey="Johannessen A">A Johannessen</name></author><author><name sortKey="Holberg Petersen, M" uniqKey="Holberg Petersen M">M Holberg-Petersen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rabenau, Hf" uniqKey="Rabenau H">HF Rabenau</name></author><author><name sortKey="Lennemann, T" uniqKey="Lennemann T">T Lennemann</name></author><author><name sortKey="Kircher, C" uniqKey="Kircher C">C Kircher</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fowotade, A" uniqKey="Fowotade A">A Fowotade</name></author><author><name sortKey="Okonko, Io" uniqKey="Okonko I">IO Okonko</name></author><author><name sortKey="Agbede, Oo" uniqKey="Agbede O">OO Agbede</name></author><author><name sortKey="Suleiman, St" uniqKey="Suleiman S">ST Suleiman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rodier, Mh" uniqKey="Rodier M">MH Rodier</name></author><author><name sortKey="Berthonneau, J" uniqKey="Berthonneau J">J Berthonneau</name></author><author><name sortKey="Bourgoin, A" uniqKey="Bourgoin A">A Bourgoin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Williams, Jo" uniqKey="Williams J">JO Williams</name></author><author><name sortKey="Fagbami, Ah" uniqKey="Fagbami A">AH Fagbami</name></author><author><name sortKey="Omilabu, Sa" uniqKey="Omilabu S">SA Omilabu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hamid, Km" uniqKey="Hamid K">KM Hamid</name></author><author><name sortKey="Onoja, Ab" uniqKey="Onoja A">AB Onoja</name></author><author><name sortKey="Tofa, Ua" uniqKey="Tofa U">UA Tofa</name></author><author><name sortKey="Garba, Kn" uniqKey="Garba K">KN Garba</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schoub, Bd" uniqKey="Schoub B">BD Schoub</name></author><author><name sortKey="Johnson, S" uniqKey="Johnson S">S Johnson</name></author><author><name sortKey="Mcanerney, Jm" uniqKey="Mcanerney J">JM McAnerney</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hannachi, N" uniqKey="Hannachi N">N Hannachi</name></author><author><name sortKey="Marzouk, M" uniqKey="Marzouk M">M Marzouk</name></author><author><name sortKey="Harrabi, I" uniqKey="Harrabi I">I Harrabi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hamdan, Hz" uniqKey="Hamdan H">HZ Hamdan</name></author><author><name sortKey="Abdelbagi, Ie" uniqKey="Abdelbagi I">IE Abdelbagi</name></author><author><name sortKey="Nasser, Nm" uniqKey="Nasser N">NM Nasser</name></author><author><name sortKey="Adam, I" uniqKey="Adam I">I Adam</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kaye, S" uniqKey="Kaye S">S Kaye</name></author><author><name sortKey="Miles, D" uniqKey="Miles D">D Miles</name></author><author><name sortKey="Antoine, P" uniqKey="Antoine P">P Antoine</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Maingi, Z" uniqKey="Maingi Z">Z Maingi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Paschale, M" uniqKey="De Paschale M">M De Paschale</name></author><author><name sortKey="Ceriani, C" uniqKey="Ceriani C">C Ceriani</name></author><author><name sortKey="Cerulli, T" uniqKey="Cerulli T">T Cerulli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kamel, N" uniqKey="Kamel N">N Kamel</name></author><author><name sortKey="Metwally, L" uniqKey="Metwally L">L Metwally</name></author><author><name sortKey="Gomaa, N" uniqKey="Gomaa N">N Gomaa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stroffolini, T" uniqKey="Stroffolini T">T Stroffolini</name></author><author><name sortKey="Ngatchu, T" uniqKey="Ngatchu T">T Ngatchu</name></author><author><name sortKey="Chiaramonte, M" uniqKey="Chiaramonte M">M Chiaramonte</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bello, C" uniqKey="Bello C">C Bello</name></author><author><name sortKey="Whittle, H" uniqKey="Whittle H">H Whittle</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Miles, Dj" uniqKey="Miles D">DJ Miles</name></author><author><name sortKey="Sande, M" uniqKey="Sande M">M Sande</name></author><author><name sortKey="Jeffries, D" uniqKey="Jeffries D">D Jeffries</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bos, P" uniqKey="Bos P">P Bos</name></author><author><name sortKey="Steele, Ad" uniqKey="Steele A">AD Steele</name></author><author><name sortKey="Peenze, I" uniqKey="Peenze I">I Peenze</name></author><author><name sortKey="Aspinall, S" uniqKey="Aspinall S">S Aspinall</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chakraborty, R" uniqKey="Chakraborty R">R Chakraborty</name></author><author><name sortKey="Rees, G" uniqKey="Rees G">G Rees</name></author><author><name sortKey="Bourboulia, D" uniqKey="Bourboulia D">D Bourboulia</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Loutfy, Sa" uniqKey="Loutfy S">SA Loutfy</name></author><author><name sortKey="Alam El Din, Hm" uniqKey="Alam El Din H">HM Alam El-Din</name></author><author><name sortKey="Ibrahim, Mf" uniqKey="Ibrahim M">MF Ibrahim</name></author><author><name sortKey="Hafez, Mm" uniqKey="Hafez M">MM Hafez</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ghebrekidan, H" uniqKey="Ghebrekidan H">H Ghebrekidan</name></author><author><name sortKey="Ruden, U" uniqKey="Ruden U">U Ruden</name></author><author><name sortKey="Cox, S" uniqKey="Cox S">S Cox</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cochereau, I" uniqKey="Cochereau I">I Cochereau</name></author><author><name sortKey="Mlika Cabanne, N" uniqKey="Mlika Cabanne N">N Mlika-Cabanne</name></author><author><name sortKey="Godinaud, P" uniqKey="Godinaud P">P Godinaud</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Taniguchi, R" uniqKey="Taniguchi R">R Taniguchi</name></author><author><name sortKey="Koyano, S" uniqKey="Koyano S">S Koyano</name></author><author><name sortKey="Suzutani, T" uniqKey="Suzutani T">T Suzutani</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Halford, Wp" uniqKey="Halford W">WP Halford</name></author><author><name sortKey="Balliet, Jw" uniqKey="Balliet J">JW Balliet</name></author><author><name sortKey="Gebhardt, Bm" uniqKey="Gebhardt B">BM Gebhardt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bello, Cs" uniqKey="Bello C">CS Bello</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Manicklal, S" uniqKey="Manicklal S">S Manicklal</name></author><author><name sortKey="Niekerk, Am" uniqKey="Niekerk A">AM Niekerk</name></author><author><name sortKey="Kroon, Sm" uniqKey="Kroon S">SM Kroon</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sande, Ma" uniqKey="Sande M">MA Sande</name></author><author><name sortKey="Kaye, S" uniqKey="Kaye S">S Kaye</name></author><author><name sortKey="Miles, Dj" uniqKey="Miles D">DJ Miles</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mwaanza, N" uniqKey="Mwaanza N">N Mwaanza</name></author><author><name sortKey="Chilukutu, L" uniqKey="Chilukutu L">L Chilukutu</name></author><author><name sortKey="Tembo, J" uniqKey="Tembo J">J Tembo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mwaniki, Mk" uniqKey="Mwaniki M">MK Mwaniki</name></author><author><name sortKey="Atieno, M" uniqKey="Atieno M">M Atieno</name></author><author><name sortKey="Lawn, Je" uniqKey="Lawn J">JE Lawn</name></author><author><name sortKey="Newton, Cr" uniqKey="Newton C">CR Newton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gumbo, H" uniqKey="Gumbo H">H Gumbo</name></author><author><name sortKey="Chasekwa, B" uniqKey="Chasekwa B">B Chasekwa</name></author><author><name sortKey="Church, Ja" uniqKey="Church J">JA Church</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Slyker, Ja" uniqKey="Slyker J">JA Slyker</name></author><author><name sortKey="Lohman Payne, Bl" uniqKey="Lohman Payne B">BL Lohman-Payne</name></author><author><name sortKey="John Stewart, Gc" uniqKey="John Stewart G">GC John-Stewart</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bates, M" uniqKey="Bates M">M Bates</name></author><author><name sortKey="Mudenda, V" uniqKey="Mudenda V">V Mudenda</name></author><author><name sortKey="Mwaba, P" uniqKey="Mwaba P">P Mwaba</name></author><author><name sortKey="Zumla, A" uniqKey="Zumla A">A Zumla</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Arnold, M" uniqKey="Arnold M">M Arnold</name></author><author><name sortKey="Itzikowitz, R" uniqKey="Itzikowitz R">R Itzikowitz</name></author><author><name sortKey="Young, B" uniqKey="Young B">B Young</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brantsaeter, Ab" uniqKey="Brantsaeter A">AB Brantsaeter</name></author><author><name sortKey="Liestol, K" uniqKey="Liestol K">K Liestol</name></author><author><name sortKey="Goplen, Ak" uniqKey="Goplen A">AK Goplen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yust, I" uniqKey="Yust I">I Yust</name></author><author><name sortKey="Fox, Z" uniqKey="Fox Z">Z Fox</name></author><author><name sortKey="Burke, M" uniqKey="Burke M">M Burke</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Bates, M" uniqKey="Bates M">M Bates</name></author><author><name sortKey="Mudenda, V" uniqKey="Mudenda V">V Mudenda</name></author><author><name sortKey="Shibemba, A" uniqKey="Shibemba A">A Shibemba</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gallant, Je" uniqKey="Gallant J">JE Gallant</name></author><author><name sortKey="Moore, Rd" uniqKey="Moore R">RD Moore</name></author><author><name sortKey="Richman, Dd" uniqKey="Richman D">DD Richman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ford, N" uniqKey="Ford N">N Ford</name></author><author><name sortKey="Shubber, Z" uniqKey="Shubber Z">Z Shubber</name></author><author><name sortKey="Saranchuk, P" uniqKey="Saranchuk P">P Saranchuk</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Curtis, Aj" uniqKey="Curtis A">AJ Curtis</name></author><author><name sortKey="Marshall, Cs" uniqKey="Marshall C">CS Marshall</name></author><author><name sortKey="Spelman, T" uniqKey="Spelman T">T Spelman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pathai, S" uniqKey="Pathai S">S Pathai</name></author><author><name sortKey="Gilbert, C" uniqKey="Gilbert C">C Gilbert</name></author><author><name sortKey="Weiss, Ha" uniqKey="Weiss H">HA Weiss</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rajasingham, R" uniqKey="Rajasingham R">R Rajasingham</name></author><author><name sortKey="Rhein, J" uniqKey="Rhein J">J Rhein</name></author><author><name sortKey="Klammer, K" uniqKey="Klammer K">K Klammer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Benjamin, La" uniqKey="Benjamin L">LA Benjamin</name></author><author><name sortKey="Kelly, M" uniqKey="Kelly M">M Kelly</name></author><author><name sortKey="Cohen, D" uniqKey="Cohen D">D Cohen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Siddiqi, Ok" uniqKey="Siddiqi O">OK Siddiqi</name></author><author><name sortKey="Ghebremichael, M" uniqKey="Ghebremichael M">M Ghebremichael</name></author><author><name sortKey="Dang, X" uniqKey="Dang X">X Dang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brantsaeter, Ab" uniqKey="Brantsaeter A">AB Brantsaeter</name></author><author><name sortKey="Liestol, K" uniqKey="Liestol K">K Liestol</name></author><author><name sortKey="Goplen, Ak" uniqKey="Goplen A">AK Goplen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lishimpi, K" uniqKey="Lishimpi K">K Lishimpi</name></author><author><name sortKey="Chintu, C" uniqKey="Chintu C">C Chintu</name></author><author><name sortKey="Lucas, S" uniqKey="Lucas S">S Lucas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cox, Ja" uniqKey="Cox J">JA Cox</name></author><author><name sortKey="Lukande, Rl" uniqKey="Lukande R">RL Lukande</name></author><author><name sortKey="Lucas, S" uniqKey="Lucas S">S Lucas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lucas, Sb" uniqKey="Lucas S">SB Lucas</name></author><author><name sortKey="Hounnou, A" uniqKey="Hounnou A">A Hounnou</name></author><author><name sortKey="Peacock, C" uniqKey="Peacock C">C Peacock</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fielding, K" uniqKey="Fielding K">K Fielding</name></author><author><name sortKey="Koba, A" uniqKey="Koba A">A Koba</name></author><author><name sortKey="Grant, Ad" uniqKey="Grant A">AD Grant</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ljungman, P" uniqKey="Ljungman P">P Ljungman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pereyra, F" uniqKey="Pereyra F">F Pereyra</name></author><author><name sortKey="Rubin, Rh" uniqKey="Rubin R">RH Rubin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Papadakis, Ka" uniqKey="Papadakis K">KA Papadakis</name></author><author><name sortKey="Tung, Jk" uniqKey="Tung J">JK Tung</name></author><author><name sortKey="Binder, Sw" uniqKey="Binder S">SW Binder</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Maher, Mm" uniqKey="Maher M">MM Maher</name></author><author><name sortKey="Nassar, Mi" uniqKey="Nassar M">MI Nassar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Deayton, Jr" uniqKey="Deayton J">JR Deayton</name></author><author><name sortKey="Prof Sabin, Ca" uniqKey="Prof Sabin C">CA Prof Sabin</name></author><author><name sortKey="Johnson, Ma" uniqKey="Johnson M">MA Johnson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chemaly, Rf" uniqKey="Chemaly R">RF Chemaly</name></author><author><name sortKey="Ullmann, Aj" uniqKey="Ullmann A">AJ Ullmann</name></author><author><name sortKey="Stoelben, S" uniqKey="Stoelben S">S Stoelben</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Milbradt, J" uniqKey="Milbradt J">J Milbradt</name></author><author><name sortKey="Auerochs, S" uniqKey="Auerochs S">S Auerochs</name></author><author><name sortKey="Korn, K" uniqKey="Korn K">K Korn</name></author><author><name sortKey="Marschall, M" uniqKey="Marschall M">M Marschall</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gantt, S" uniqKey="Gantt S">S Gantt</name></author><author><name sortKey="Huang, Ml" uniqKey="Huang M">ML Huang</name></author><author><name sortKey="Magaret, A" uniqKey="Magaret A">A Magaret</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Roxby, Ac" uniqKey="Roxby A">AC Roxby</name></author><author><name sortKey="Atkinson, C" uniqKey="Atkinson C">C Atkinson</name></author><author><name sortKey="Asbjornsdottir, K" uniqKey="Asbjornsdottir K">K Asbjornsdottir</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sissons, Jg" uniqKey="Sissons J">JG Sissons</name></author><author><name sortKey="Wills, Mr" uniqKey="Wills M">MR Wills</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Miles, Dj" uniqKey="Miles D">DJ Miles</name></author><author><name sortKey="Sande, M" uniqKey="Sande M">M Sande</name></author><author><name sortKey="Jeffries, D" uniqKey="Jeffries D">D Jeffries</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ben Smith, A" uniqKey="Ben Smith A">A Ben-Smith</name></author><author><name sortKey="Gorak Stolinska, P" uniqKey="Gorak Stolinska P">P Gorak-Stolinska</name></author><author><name sortKey="Floyd, S" uniqKey="Floyd S">S Floyd</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Portevin, D" uniqKey="Portevin D">D Portevin</name></author><author><name sortKey="Moukambi, F" uniqKey="Moukambi F">F Moukambi</name></author><author><name sortKey="Mpina, M" uniqKey="Mpina M">M Mpina</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Goovaerts, O" uniqKey="Goovaerts O">O Goovaerts</name></author><author><name sortKey="Jennes, W" uniqKey="Jennes W">W Jennes</name></author><author><name sortKey="Massinga Loembe, M" uniqKey="Massinga Loembe M">M Massinga-Loembe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Riou, C" uniqKey="Riou C">C Riou</name></author><author><name sortKey="Tanko, Rf" uniqKey="Tanko R">RF Tanko</name></author><author><name sortKey="Soares, Ap" uniqKey="Soares A">AP Soares</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="editorial"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Virus Erad</journal-id><journal-id journal-id-type="iso-abbrev">J Virus Erad</journal-id><journal-id journal-id-type="publisher-id">JOURNAL OF VIRUS ERADICATION</journal-id><journal-title-group><journal-title>Journal of Virus Eradication</journal-title></journal-title-group><issn pub-type="ppub">2055-6640</issn><issn pub-type="epub">2055-6659</issn><publisher><publisher-name>Mediscript Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27482452</article-id><article-id pub-id-type="pmc">4967964</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review</subject></subj-group></article-categories><title-group><article-title>Human cytomegalovirus (CMV) in Africa: a neglected but important pathogen</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Bates</surname><given-names>Matthew</given-names></name><xref ref-type="aff" rid="jve5-aff-0001"><sup>1</sup></xref><xref ref-type="aff" rid="jve5-aff-0002"><sup>2</sup></xref><xref ref-type="corresp" rid="an1">*</xref></contrib><contrib contrib-type="author"><name><surname>Brantsaeter</surname><given-names>Arne Broch</given-names></name><xref ref-type="aff" rid="jve5-aff-0003"><sup>3</sup></xref></contrib><aff id="jve5-aff-0001"><label><sup>1</sup></label><institution>HerpeZ</institution>,<institution>University Teaching Hospital</institution>,<addr-line>Lusaka</addr-line>,<country>Zambia</country></aff><aff id="jve5-aff-0002"><label><sup>2</sup></label><institution>University of Zambia and University College London Medical School (UNZA-UCLMS) Research and Training Programme</institution>,<institution>University Teaching Hospital</institution>,<addr-line>Lusaka</addr-line>,<country>Zambia</country></aff><aff id="jve5-aff-0003"><label><sup>3</sup></label><institution>Department of Infectious Diseases and Department of Acute Medicine</institution>,<institution>Oslo University Hospital Ullevål</institution>,<addr-line>Oslo</addr-line>,<country>Norway</country></aff></contrib-group><author-notes><corresp id="an1"><label>*</label>Corresponding author: Matthew Bates,
<institution>UNZA-UCLMS Research & Training Programme</institution>,
<institution>University Teaching Hospital</institution>,
<addr-line>Nationalist Road</addr-line>,
<addr-line>RW1X</addr-line>,
<addr-line>Lusaka</addr-line>,
<country>Zambia</country>Email:
<email>matthew.bates@ucl.ac.uk</email></corresp></author-notes><pub-date date-type="collection" publication-format="electronic"><month>7</month><year>2016</year></pub-date><pub-date date-type="pub" publication-format="electronic"><day>1</day><month>7</month><year>2016</year></pub-date><volume>2</volume><issue>3</issue><fpage>136</fpage><lpage>142</lpage><permissions><copyright-statement>© 2016 The Authors. <italic>Journal of Virus Eradication</italic> published by Mediscript Ltd</copyright-statement><license license-type="open-access"><license-p>This is an open access article published under the terms of a Creative Commons License.</license-p></license></permissions><abstract id="jve5-abs-0001"><title>Abstract</title><p id="jve5-para-0001">In Africa, human cytomegalovirus (CMV) is an important pathogen in a diverse range of patient groups. Congenital CMV infection is common, and most children undergo primary infection during the first year of life. Preliminary studies suggest that these early primary CMV infections could have population-wide effects on growth and development. In most studies of adults, CMV seroprevalence is close to 100%, but some studies have found that significant minorities of adults are seronegative. CMV is a common cause of pneumonia and meningitis in hospitalised immunosuppressed patient groups, and CMV DNAemia may be an important marker of rapid progression and poor outcomes of HIV infection, despite roll-out of antiretroviral therapy (ART). Diagnosis and treatment of CMV-related disease is broadly neglected in Africa, and no randomised clinical trials of anti-CMV drugs have been conducted to date. Autopsy is rarely performed in Africa, but identifies CMV as a frequent pathogen when it is carried out. Here we review the available literature on CMV in Africa, primarily in adult patients, and discuss this in the context of contemporary understanding of CMV as a human pathogen.</p></abstract></article-meta></front><body><sec id="jve5-sec-0001"><title id="jve5-title-0002">Introduction</title><p id="jve5-para-0002">There is growing awareness of the possible importance of human cytomegalovirus (CMV) as a cause or contributory factor in a range of disease conditions in Africa and other developing regions globally. In children, CMV is a common congenital infection the outcomes of which are largely undefined in African populations <xref rid="jve5-bib-0001" ref-type="bibr">[1–3]</xref>. CMV is also an important cause of pneumonia <xref rid="jve5-bib-0004" ref-type="bibr">[4–6]</xref> and meningitis <xref rid="jve5-bib-0007" ref-type="bibr">[7,8]</xref>, strongly associated with HIV infection and exposure, and is independently associated with impaired physical development <xref rid="jve5-bib-0007" ref-type="bibr">[7,9]</xref>. CMV is an important co-infection in HIV-infected adult patient groups, and is associated with increased morbidity and mortality <xref rid="jve5-bib-0010" ref-type="bibr">[10,11]</xref>, yet diagnosis and treatment are broadly unavailable outside selected centres of excellence.</p><p id="jve5-para-0003">CMV infection in Africa has been overlooked for several reasons. 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 <xref rid="jve5-bib-0012" ref-type="bibr">[12–14]</xref>. However, even in high-income populations, the majority of congenital CMV infections are the result of maternal reactivation or re-infection <xref rid="jve5-bib-0015" ref-type="bibr">[15]</xref>. Ignoring congenital CMV infection in Africa is therefore shortsighted, and does not consider the possible confounding effects of HIV infection, malnutrition, tuberculosis, and a general higher disease burden. Secondly, CMV disease is an AIDS-defining opportunistic infection <xref rid="jve5-bib-0016" ref-type="bibr">[16]</xref>. With the roll-out of ART across Africa, it has been assumed that the burden of disease caused by CMV is small and getting smaller <xref rid="jve5-bib-0010" ref-type="bibr">[10]</xref>, and as a result CMV diagnostics and treatment are broadly unavailable outside selected centres of excellence <xref rid="jve5-bib-0002" ref-type="bibr">[2,4–6]</xref>. Thirdly, there is an assumption that patients in Africa do not receive immunosuppressive therapy that may cause CMV disease, an increasingly obsolete view as access to more advanced treatments and therapies for non-communicable diseases as well as organ transplantation become more available <xref rid="jve5-bib-0017" ref-type="bibr">[17,18]</xref>.</p><p id="jve5-para-0004">In this review we summarise available data on CMV infections in Africa, from the vast literature of CMV pathogenicity, immunology, diagnosis and treatment available from studies undertaken in high-income countries.</p></sec><sec id="jve5-sec-0002"><title id="jve5-title-0003">Seroprevalence</title><p id="jve5-para-0005">As for all herpesviruses, the natural host immune response to primary CMV infection does not clear the virus completely, and it persists in a latent or ‘non-lytic’ state <xref rid="jve5-bib-0019" ref-type="bibr">[19]</xref>. In lower-income settings, primary infection with CMV generally occurs earlier <xref rid="jve5-bib-0009" ref-type="bibr">[9,20–22]</xref> than in higher-income settings <xref rid="jve5-bib-0023" ref-type="bibr">[23]</xref> (although this is not universally true, as high prevalence of CMV IgG has been reported in studies from Finland and Japan <xref rid="jve5-bib-0024" ref-type="bibr">[24–26]</xref>). Data from the United States have suggested that non-white ethnicity and lower socioeconomic status could be responsible for a 10–30% increase in CMV seroprevalence <xref rid="jve5-bib-0027" ref-type="bibr">[27]</xref>, although ethnic differences should be interpreted with caution: there are no race-associated host genetic polymorphisms known to be linked with earlier acquisition of CMV. Social and environmental factors are the most probable determinants of age of acquisition, and even when seroprevalence differences by ethnicity hold when adjusting for socioeconomic status, such as in an Israeli study <xref rid="jve5-bib-0028" ref-type="bibr">[28]</xref>, it could be socioeconomic status during childhood that is important. For instance, migrants who spent their childhood in sub-Saharan Africa might be more likely to be CMV IgG seropositive, even if social mobility facilitated a rise in socioeconomic status after settling in Israel.</p><p id="jve5-para-0006">We searched PubMed and identified 33 studies that present CMV seroprevalence data from healthy blood donors and patient groups in Africa (Table <xref ref-type="table" rid="jve5-tbl-0001">1</xref>). The pooled prevalence of CMV IgG among HIV-negative adults was 81.8% (range 55–97%). For HIV-infected adults the pooled CMV IgG seroprevalence was lower among those with clinically defined AIDS (81.9%, range 59–100%) than among asymptomatic HIV-infected adults (94.8%, range 71–100%), consistent with the notion of weaker humoral responses associated with AIDS progression <xref rid="jve5-bib-0029" ref-type="bibr">[29]</xref>. It is also possible that some non-HIV-infected adults are infected but do not mount a measurable IgG response. Among pregnant women seroprevalence mirrored that among healthy blood donors, although the HIV status of participants was not always stated (Table <xref ref-type="table" rid="jve5-tbl-0001">1</xref>).</p><table-wrap id="jve5-tbl-0001" orientation="portrait" position="float"><label>Table 1.</label><caption><p id="jve5-para-0007">Comparison of human CMV seroprevalence in different countries in Africa</p></caption><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col></colgroup><thead><tr><th rowspan="1" colspan="1">Country (City)</th><th rowspan="1" colspan="1">HCMV IgG</th><th rowspan="1" colspan="1">Study population</th><th rowspan="1" colspan="1">N</th><th rowspan="1" colspan="1">Assay</th><th rowspan="1" colspan="1">Reference</th></tr></thead><tbody><tr><td rowspan="1" colspan="1"><bold>HIV-negative adults</bold></td><td rowspan="1" colspan="1"><bold>81.8%</bold></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"> Nigeria (Ibadan)</td><td rowspan="1" colspan="1">55.0%</td><td rowspan="1" colspan="1">Adult healthy blood donors</td><td rowspan="1" colspan="1">110</td><td rowspan="1" colspan="1">Complement fixation</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0030" ref-type="bibr">[30]</xref></td></tr><tr><td rowspan="1" colspan="1"> Mali (Bamako)</td><td rowspan="1" colspan="1">58.0%</td><td rowspan="1" colspan="1">Adult healthy HIV-negative blood donors</td><td rowspan="1" colspan="1">100</td><td rowspan="1" colspan="1">ELISA (Platelia, Sanofi Pasteur)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0031" ref-type="bibr">[31]</xref></td></tr><tr><td rowspan="1" colspan="1"> Tanzania (Dar es Salaam)</td><td rowspan="1" colspan="1">66.9%</td><td rowspan="1" colspan="1">Adult inpatients with STDs (HIV-negative)</td><td rowspan="1" colspan="1">158</td><td rowspan="1" colspan="1">Passive latex agglutination (CMV-scan card)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0032" ref-type="bibr">[32]</xref></td></tr><tr><td rowspan="1" colspan="1"> Ghana (Accra)</td><td rowspan="1" colspan="1">77.6%</td><td rowspan="1" colspan="1">Adult healthy HIV-negative blood donors</td><td rowspan="1" colspan="1">3275</td><td rowspan="1" colspan="1">ELISA IgG (Diamedix Corporation, USA)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0033" ref-type="bibr">[33]</xref></td></tr><tr><td rowspan="1" colspan="1"> Burkina Faso (Bobo-Dioulasso)</td><td rowspan="1" colspan="1">82.0%</td><td rowspan="1" colspan="1">Adult healthy HIV-negative blood donors</td><td rowspan="1" colspan="1">28</td><td rowspan="1" colspan="1">ELISA (Platelia, Sanofi Pasteur)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0034" ref-type="bibr">[34]</xref></td></tr><tr><td rowspan="1" colspan="1"> Ghana (Kumasi)</td><td rowspan="1" colspan="1">94.3%</td><td rowspan="1" colspan="1">Healthy blood donors</td><td rowspan="1" colspan="1">112</td><td rowspan="1" colspan="1">Platella CMV IgG (Bio-Rad)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0035" ref-type="bibr">[35]</xref></td></tr><tr><td rowspan="1" colspan="1"> Somalia (Mogadishu)</td><td rowspan="1" colspan="1">96.0%</td><td rowspan="1" colspan="1">Healthy adult males</td><td rowspan="1" colspan="1">102</td><td rowspan="1" colspan="1">Unspecified</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0036" ref-type="bibr">[36]</xref></td></tr><tr><td rowspan="1" colspan="1"> Somalia (Mogadishu)</td><td rowspan="1" colspan="1">96.0%</td><td rowspan="1" colspan="1">Adult males attending STD clinic</td><td rowspan="1" colspan="1">101</td><td rowspan="1" colspan="1">Unspecified</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0036" ref-type="bibr">[36]</xref></td></tr><tr><td rowspan="1" colspan="1"> Kenya (Nairobi)</td><td rowspan="1" colspan="1">97.0%</td><td rowspan="1" colspan="1">Adult healthy blood donors (1.3% HIV-positive)</td><td rowspan="1" colspan="1">400</td><td rowspan="1" colspan="1">Unspecified</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0037" ref-type="bibr">[37]</xref></td></tr><tr><td rowspan="1" colspan="1"> Tunisia (Tunis)</td><td rowspan="1" colspan="1">89.0%</td><td rowspan="1" colspan="1">Healthy adults</td><td rowspan="1" colspan="1">100</td><td rowspan="1" colspan="1">CMV IgG CMIA (Abbott Diagnostics)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0038" ref-type="bibr">[38]</xref></td></tr><tr><td rowspan="1" colspan="1"> Kenya</td><td rowspan="1" colspan="1">97.0%</td><td rowspan="1" colspan="1">Adult healthy blood donors</td><td rowspan="1" colspan="1">395</td><td rowspan="1" colspan="1">Not available</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0037" ref-type="bibr">[37]</xref></td></tr><tr><td rowspan="1" colspan="1"> Tunisia (Sfax)</td><td rowspan="1" colspan="1">97.0%</td><td rowspan="1" colspan="1">Adult healthy blood donors</td><td rowspan="1" colspan="1">280</td><td rowspan="1" colspan="1">Enzygnost anti-CMV/IgG (Behring)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0039" ref-type="bibr">[39]</xref></td></tr><tr><td rowspan="1" colspan="1"><bold>HIV-positive adults</bold></td><td rowspan="1" colspan="1"><bold>94.8%</bold></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"> Mali (Bamako)</td><td rowspan="1" colspan="1">71.0%</td><td rowspan="1" colspan="1">HIV-positive adults</td><td rowspan="1" colspan="1">100</td><td rowspan="1" colspan="1">ELISA (Platelia, Sanofi Pasteur)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0031" ref-type="bibr">[31]</xref></td></tr><tr><td rowspan="1" colspan="1"> Tanzania (Dar es Salaam)</td><td rowspan="1" colspan="1">72.3%</td><td rowspan="1" colspan="1">Adult inpatients with STDs (HIV-positive)</td><td rowspan="1" colspan="1">65</td><td rowspan="1" colspan="1">Passive latex agglutination (CMV-scan card)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0032" ref-type="bibr">[32]</xref></td></tr><tr><td rowspan="1" colspan="1"> Ghana (Kumasi)</td><td rowspan="1" colspan="1">92.7%</td><td rowspan="1" colspan="1">Asymptomatic HIV-positive adults</td><td rowspan="1" colspan="1">55</td><td rowspan="1" colspan="1">Platella CMV IgG (Bio-Rad)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0035" ref-type="bibr">[35]</xref></td></tr><tr><td rowspan="1" colspan="1"> Botswana (Gaborone)</td><td rowspan="1" colspan="1">95.3%</td><td rowspan="1" colspan="1">Asymptomatic HIV-positive adults</td><td rowspan="1" colspan="1">43</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0040" ref-type="bibr">[40]</xref></td></tr><tr><td rowspan="1" colspan="1"> South Africa (Mopani District, Limpopo)</td><td rowspan="1" colspan="1">100.0%</td><td rowspan="1" colspan="1">HIV-positive adults, ART naïve, mean CD4 cell count 382±226 cells/μL</td><td rowspan="1" colspan="1">405</td><td rowspan="1" colspan="1">Serion ELISA classic tests (Virion Serion)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0041" ref-type="bibr">[41]</xref></td></tr><tr><td rowspan="1" colspan="1"> Tanzania (Mbulu)</td><td rowspan="1" colspan="1">100.0%</td><td rowspan="1" colspan="1">HIV-positive adults, ART naïve, median baseline CD4 cell count 205 (IQR 79–403) cells/μL</td><td rowspan="1" colspan="1">168</td><td rowspan="1" colspan="1">CMV IgG CMIA (Abbott Diagnostics)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0042" ref-type="bibr">[42]</xref></td></tr><tr><td rowspan="1" colspan="1"> Lesotho</td><td rowspan="1" colspan="1">100.0%</td><td rowspan="1" colspan="1">HIV-positive, on ART</td><td rowspan="1" colspan="1">205</td><td rowspan="1" colspan="1">CMV IgG CMIA (Abbott Diagnostics)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0043" ref-type="bibr">[43]</xref></td></tr><tr><td rowspan="1" colspan="1"> Nigeria (Ilorin)</td><td rowspan="1" colspan="1">93.9%</td><td rowspan="1" colspan="1">Asymptomatic HIV-positive adults</td><td rowspan="1" colspan="1">180</td><td rowspan="1" colspan="1">IgG ELISA Kit (DIA.PRO, Diagnostic Bioprobes, Italy)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0044" ref-type="bibr">[44]</xref></td></tr><tr><td rowspan="1" colspan="1"><bold>AIDS patients</bold></td><td rowspan="1" colspan="1"><bold>81.9%</bold></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"> Ghana (Accra)</td><td rowspan="1" colspan="1">59.2%</td><td rowspan="1" colspan="1">AIDS patients</td><td rowspan="1" colspan="1">250</td><td rowspan="1" colspan="1">ELISA IgG; Diamedix Corporation, USA</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0033" ref-type="bibr">[33]</xref></td></tr><tr><td rowspan="1" colspan="1"> Mali (Bamako)</td><td rowspan="1" colspan="1">89.0%</td><td rowspan="1" colspan="1">AIDS patients</td><td rowspan="1" colspan="1">100</td><td rowspan="1" colspan="1">ELISA (Platelia, Sanofi Pasteur)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0031" ref-type="bibr">[31]</xref></td></tr><tr><td rowspan="1" colspan="1"> Tanzania (Dar es Salaam)</td><td rowspan="1" colspan="1">90.7%</td><td rowspan="1" colspan="1">AIDS patients</td><td rowspan="1" colspan="1">43</td><td rowspan="1" colspan="1">Passive latex agglutination (CMV-scan card)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0032" ref-type="bibr">[32]</xref></td></tr><tr><td rowspan="1" colspan="1"> Ghana (Kumasi)</td><td rowspan="1" colspan="1">98.3%</td><td rowspan="1" colspan="1">AIDS patients</td><td rowspan="1" colspan="1">239</td><td rowspan="1" colspan="1">Platella CMV IgG (Bio-Rad)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0035" ref-type="bibr">[35]</xref></td></tr><tr><td rowspan="1" colspan="1"> Burkina Faso (Bobo-Dioulasso)</td><td rowspan="1" colspan="1">100.0%</td><td rowspan="1" colspan="1">AIDS patients</td><td rowspan="1" colspan="1">36</td><td rowspan="1" colspan="1">ELISA (Platelia, Sanofi Pasteur)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0034" ref-type="bibr">[34]</xref></td></tr><tr><td rowspan="1" colspan="1"><bold>Pregnant women</bold></td><td rowspan="1" colspan="1"><bold>87.8%</bold></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"> Tanzania (Dar es Salaam)</td><td rowspan="1" colspan="1">60.6%</td><td rowspan="1" colspan="1">HIV-negative pregnant women</td><td rowspan="1" colspan="1">127</td><td rowspan="1" colspan="1">Passive latex agglutination (CMV-scan card)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0032" ref-type="bibr">[32]</xref></td></tr><tr><td rowspan="1" colspan="1"> Tanzania (Dar es Salaam)</td><td rowspan="1" colspan="1">85.7%</td><td rowspan="1" colspan="1">HIV-positive pregnant women</td><td rowspan="1" colspan="1">14</td><td rowspan="1" colspan="1">Passive latex agglutination (CMV-scan card)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0032" ref-type="bibr">[32]</xref></td></tr><tr><td rowspan="1" colspan="1"> Benin (Cotonou)</td><td rowspan="1" colspan="1">97.2%</td><td rowspan="1" colspan="1">Pregnant women</td><td rowspan="1" colspan="1">211</td><td rowspan="1" colspan="1">ETI-CYTOK-G PLUS ELISA (DiaSorin)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0045" ref-type="bibr">[45]</xref></td></tr><tr><td rowspan="1" colspan="1"> Nigeria (Ibadan)</td><td rowspan="1" colspan="1">100.0%</td><td rowspan="1" colspan="1">Pregnant and non-pregnant women</td><td rowspan="1" colspan="1">80</td><td rowspan="1" colspan="1">Peroxidase enzyme-labelled antigen (ELA)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0046" ref-type="bibr">[46]</xref></td></tr><tr><td rowspan="1" colspan="1"> Nigeria (Kano)</td><td rowspan="1" colspan="1">91.1%</td><td rowspan="1" colspan="1">Pregnant women</td><td rowspan="1" colspan="1">180</td><td rowspan="1" colspan="1">CMV IgG ELISA kit (Dialab, Austria)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0047" ref-type="bibr">[47]</xref></td></tr><tr><td rowspan="1" colspan="1"> South Africa (Johannesburg)</td><td rowspan="1" colspan="1">86.4%</td><td rowspan="1" colspan="1">Pregnant women</td><td rowspan="1" colspan="1">2160</td><td rowspan="1" colspan="1">ELISA (M A Bioproducts, Virginia)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0048" ref-type="bibr">[48]</xref></td></tr><tr><td rowspan="1" colspan="1"> Tunisia</td><td rowspan="1" colspan="1">80.9%</td><td rowspan="1" colspan="1">Pregnant women</td><td rowspan="1" colspan="1">404</td><td rowspan="1" colspan="1">CMV IgG CMIA (Abbott Diagnostics)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0049" ref-type="bibr">[49]</xref></td></tr><tr><td rowspan="1" colspan="1"> Sudan</td><td rowspan="1" colspan="1">72.0%</td><td rowspan="1" colspan="1">Pregnant women</td><td rowspan="1" colspan="1">231</td><td rowspan="1" colspan="1">DRG Cytomegalie Virus (CMV) IgG Enzyme Immunoassay Kit</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0050" ref-type="bibr">[50]</xref></td></tr><tr><td rowspan="1" colspan="1"> The Gambia (Sukuta)</td><td rowspan="1" colspan="1">100.0%</td><td rowspan="1" colspan="1">Pregnant women</td><td rowspan="1" colspan="1">169</td><td rowspan="1" colspan="1">ETI-CYTOK-G PLUS ELISA (DiaSorin)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0051" ref-type="bibr">[51]</xref></td></tr><tr><td rowspan="1" colspan="1"> Kenya (Thika)</td><td rowspan="1" colspan="1">77.3%</td><td rowspan="1" colspan="1">Pregnant women</td><td rowspan="1" colspan="1">260</td><td rowspan="1" colspan="1">CMV serum immunoglobulin G antibody using a commercial enzyme-linked immunosorbent assay (Wampole; Inverness Medical Professional Diagnostics)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0052" ref-type="bibr">[52]</xref></td></tr><tr><td rowspan="1" colspan="1"> Benin (Tanguiéta)</td><td rowspan="1" colspan="1">100.0%</td><td rowspan="1" colspan="1">Pregnant women</td><td rowspan="1" colspan="1">283</td><td rowspan="1" colspan="1">ETI-CYTOK-G PLUS ELISA (DiaSorin)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0053" ref-type="bibr">[53]</xref></td></tr><tr><td rowspan="1" colspan="1"> Egypt (Ismailia)</td><td rowspan="1" colspan="1">100.0%</td><td rowspan="1" colspan="1">Pregnant women</td><td rowspan="1" colspan="1">546</td><td rowspan="1" colspan="1">CMV IgG (DIA.PRO Diagnostic Bioprobes, Italy)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0054" ref-type="bibr">[54]</xref></td></tr><tr><td rowspan="1" colspan="1"><bold>Children</bold></td><td rowspan="1" colspan="1"><bold>88.1%</bold></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"> Cameroon (Kumba City)</td><td rowspan="1" colspan="1">88.5%</td><td rowspan="1" colspan="1">Healthy children 4–6 years</td><td rowspan="1" colspan="1">~100</td><td rowspan="1" colspan="1">ELISA (unspecified)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0055" ref-type="bibr">[55]</xref></td></tr><tr><td rowspan="1" colspan="1"> Cameroon (Kumba City)</td><td rowspan="1" colspan="1">98.0%</td><td rowspan="1" colspan="1">Healthy children 11–14 years</td><td rowspan="1" colspan="1">~100</td><td rowspan="1" colspan="1">ELISA (unspecified)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0055" ref-type="bibr">[55]</xref></td></tr><tr><td rowspan="1" colspan="1"> Gambia (Banjul)</td><td rowspan="1" colspan="1">86.4%</td><td rowspan="1" colspan="1">Healthy children 12 months</td><td rowspan="1" colspan="1">178</td><td rowspan="1" colspan="1">Immunofluorescence?</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0056" ref-type="bibr">[56]</xref></td></tr><tr><td rowspan="1" colspan="1"> Gambia (Banjul)</td><td rowspan="1" colspan="1">80.4%</td><td rowspan="1" colspan="1">Healthy children</td><td rowspan="1" colspan="1">138</td><td rowspan="1" colspan="1">ETI-CYTOK-G PLUS ELISA (DiaSorin)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0057" ref-type="bibr">[57]</xref></td></tr><tr><td rowspan="1" colspan="1"> Mozambique (SE Transvaal)</td><td rowspan="1" colspan="1">88.0%</td><td rowspan="1" colspan="1">Refugee children under 5 years</td><td rowspan="1" colspan="1">~100</td><td rowspan="1" colspan="1">ELISA (unspecified)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0058" ref-type="bibr">[58]</xref></td></tr><tr><td rowspan="1" colspan="1"> Mozambique (SE Transvaal)</td><td rowspan="1" colspan="1">96.4%</td><td rowspan="1" colspan="1">Refugee children under 11 years</td><td rowspan="1" colspan="1">~100</td><td rowspan="1" colspan="1">ELISA (unspecified)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0058" ref-type="bibr">[58]</xref></td></tr><tr><td rowspan="1" colspan="1"> Nigeria (Ibadan)</td><td rowspan="1" colspan="1">100.0%</td><td rowspan="1" colspan="1">Newborn infants</td><td rowspan="1" colspan="1">21</td><td rowspan="1" colspan="1">Peroxidase enzyme-labelled antigen (ELA)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0046" ref-type="bibr">[46]</xref></td></tr><tr><td rowspan="1" colspan="1"> Zambia (Lusaka)</td><td rowspan="1" colspan="1">83.0%</td><td rowspan="1" colspan="1">Healthy 18-month-old infants</td><td rowspan="1" colspan="1">460</td><td rowspan="1" colspan="1">ETI-CYTOK-G PLUS ELISA (DiaSorin)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0009" ref-type="bibr">[9]</xref></td></tr><tr><td rowspan="1" colspan="1"> Kenya (Nairobi)</td><td rowspan="1" colspan="1">100.0%</td><td rowspan="1" colspan="1">HIV-1-infected street children</td><td rowspan="1" colspan="1">71</td><td rowspan="1" colspan="1">ELISA kit (Murex)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0059" ref-type="bibr">[59]</xref></td></tr><tr><td rowspan="1" colspan="1"> Egypt</td><td rowspan="1" colspan="1">100.0%</td><td rowspan="1" colspan="1">Acute lymphoblastic leukaemia</td><td rowspan="1" colspan="1">68</td><td rowspan="1" colspan="1">ELISA kit (Diagnostic Systems Laboratories, Inc., USA)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0060" ref-type="bibr">[60]</xref></td></tr><tr><td rowspan="1" colspan="1"><bold>Tuberculosis studies</bold></td><td rowspan="1" colspan="1"><bold>83.0%</bold></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"> Nigeria (Ibadan)</td><td rowspan="1" colspan="1">50.6%</td><td rowspan="1" colspan="1">Non-TB</td><td rowspan="1" colspan="1">89</td><td rowspan="1" colspan="1">Complement fixation</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0030" ref-type="bibr">[30]</xref></td></tr><tr><td rowspan="1" colspan="1"> Nigeria (Ibadan)</td><td rowspan="1" colspan="1">87.6%</td><td rowspan="1" colspan="1">Tuberculosis patients</td><td rowspan="1" colspan="1">161</td><td rowspan="1" colspan="1">Complement fixation</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0030" ref-type="bibr">[30]</xref></td></tr><tr><td rowspan="1" colspan="1"> Burkina Faso (Bobo-Dioulasso)</td><td rowspan="1" colspan="1">95.0%</td><td rowspan="1" colspan="1">TB-positive, HIV-positive</td><td rowspan="1" colspan="1">40</td><td rowspan="1" colspan="1">ELISA (Platelia, Sanofi Pasteur)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0034" ref-type="bibr">[34]</xref></td></tr><tr><td rowspan="1" colspan="1"> Burkina Faso (Bobo-Dioulasso)</td><td rowspan="1" colspan="1">96.5%</td><td rowspan="1" colspan="1">Tuberculosis patients</td><td rowspan="1" colspan="1">80</td><td rowspan="1" colspan="1">ELISA (Platelia, Sanofi Pasteur)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0034" ref-type="bibr">[34]</xref></td></tr><tr><td rowspan="1" colspan="1"> Burkina Faso (Bobo-Dioulasso)</td><td rowspan="1" colspan="1">97.5%</td><td rowspan="1" colspan="1">TB-positive, HIV-negative</td><td rowspan="1" colspan="1">40</td><td rowspan="1" colspan="1">ELISA (Platelia, Sanofi Pasteur)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0034" ref-type="bibr">[34]</xref></td></tr><tr><td rowspan="1" colspan="1"><bold>Other</bold></td><td rowspan="1" colspan="1"><bold>94.5%</bold></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td rowspan="1" colspan="1"> Eritrea (various locations)</td><td rowspan="1" colspan="1">94.8%</td><td rowspan="1" colspan="1">Various</td><td rowspan="1" colspan="1">439</td><td rowspan="1" colspan="1">ELISA (unspecified)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0061" ref-type="bibr">[61]</xref></td></tr><tr><td rowspan="1" colspan="1"> Burundi (Bujumbura)</td><td rowspan="1" colspan="1">99.0%</td><td rowspan="1" colspan="1">Ophthalmic patients</td><td rowspan="1" colspan="1">154</td><td rowspan="1" colspan="1">ELISA Enzygnost CMV (Abbott Laboratories, USA)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0062" ref-type="bibr">[62]</xref></td></tr><tr><td rowspan="1" colspan="1"> Tunisia</td><td rowspan="1" colspan="1">94.9%</td><td rowspan="1" colspan="1">HIV-negative adults with haemoglobinopathies</td><td rowspan="1" colspan="1">59</td><td rowspan="1" colspan="1">CMV IgG CMIA (Abbott Diagnostics)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0038" ref-type="bibr">[38]</xref></td></tr><tr><td rowspan="1" colspan="1"> Tunisia</td><td rowspan="1" colspan="1">77.0%</td><td rowspan="1" colspan="1">HIV-negative children with thalassemia or haemophilia</td><td rowspan="1" colspan="1">48</td><td rowspan="1" colspan="1">CMV IgG CMIA (Abbott Diagnostics)</td><td rowspan="1" colspan="1"><xref rid="jve5-bib-0038" ref-type="bibr">[38]</xref></td></tr></tbody></table><table-wrap-foot><fn id="jve5-fn-0001"><p id="jve5-para-0008">Adapted from <xref rid="jve5-bib-0002" ref-type="bibr">[2]</xref>. Percentages in bold are the averages within each group, weighted by study size. CMIA, chemiluminescent microparticle immunoassay</p></fn></table-wrap-foot></table-wrap><p id="jve5-para-0009">The number of children screened for CMV IgG was an order of magnitude less than for adults, but pooled seroprevalence was 88.1% (range 80–100%). With this very high seroprevalence in children (Table <xref ref-type="table" rid="jve5-tbl-0001">1</xref>), even in very young infants <xref rid="jve5-bib-0009" ref-type="bibr">[9]</xref>, one would expect seroprevalence among adults to be consistently close to 100%. It is therefore surprising that a significant minority of adults in many studies are CMV IgG negative. Our pooled analysis of CMV IgG seroprevalence is limited by the lack of data on confounding variables and the use of different CMV IgG assays in different studies, but CMV IgG is considered to be a readily detectable biomarker, with many of the assays cited used routinely in the transplant setting to define the CMV exposure of donor and recipient. As detection of pathogen-specific IgG is the very backbone of diagnostic programmes for HIV, malaria and many other common infections, it seems unlikely, with the exception of HIV-infected individuals, that the reason is impaired humoral response to CMV, which is known for high immunogenicity. Therefore, it cannot be excluded that seronegative adults are protected from CMV infection in some unknown way. Possible explanations include socioeconomic and host genetic factors. Studying the host genetics of CMV-seronegative African adults may identify novel markers of protection. Recently, Japanese researchers found that the polymorphism Thr72Ala in NKG2D, a leptin-like receptor expressed by NK cells, might be associated with symptomatic congenital CMV infection <xref rid="jve5-bib-0063" ref-type="bibr">[63]</xref>. Host polymorphisms in mice have also been associated with differential pathogenicity to HSV-1 <xref rid="jve5-bib-0064" ref-type="bibr">[64]</xref>, but there is currently no evidence of a host polymorphism in humans that results in a sufficiently rapid innate immune response that prevents establishment of humoral immunity to herpesviruses.</p></sec><sec id="jve5-sec-0003"><title id="jve5-title-0004">CMV infections in African children</title><p id="jve5-para-0010">A detailed discussion of this topic is planned for a later issue of the <italic>Journal of Virus Eradication</italic>. For this reason, we only summarise here. CMV is important in African children for two reasons. First, congenital CMV infection appears to be highly prevalent <xref rid="jve5-bib-0065" ref-type="bibr">[65–67]</xref> despite pre-existing maternal immunity, and is strongly associated with maternal HIV infection <xref rid="jve5-bib-0068" ref-type="bibr">[68]</xref>. The longitudinal outcomes of congenital CMV infection (cCMV) in Africa have not been thoroughly studied, but cases of sensorineural hearing loss and sudden infant death have been documented <xref rid="jve5-bib-0056" ref-type="bibr">[56]</xref>. There is an emerging consensus that cCMV, along with other congenital and neonatal infections, is an under-appreciated cause of morbidity and mortality in African children <xref rid="jve5-bib-0069" ref-type="bibr">[69]</xref>. Secondly, most African children are infected with CMV early in infancy irrespective of HIV infection or exposure <xref rid="jve5-bib-0005" ref-type="bibr">[5,9,70,71]</xref>, which is distinctly different from higher-income settings where primary infection with CMV generally occurs much later. Traditionally cCMV has been defined as detection of CMV within 3 weeks postpartum, but in Africa many infants undergo non-congenital primary CMV infection soon after this cut-off <xref rid="jve5-bib-0005" ref-type="bibr">[5]</xref>, and preliminary studies suggest these early infant non-congenital infections could also be associated with developmental sequelae. CMV shedding in African infants is associated with vertical transmission of HIV <xref rid="jve5-bib-0071" ref-type="bibr">[71]</xref>, and these early infant non-congenital CMV infections are independently associated with impaired physical development, and among HIV-exposed children, impaired psychomotor development <xref rid="jve5-bib-0009" ref-type="bibr">[9]</xref>. CMV pneumonia is the most prevalent acute disease presentation <xref rid="jve5-bib-0072" ref-type="bibr">[72]</xref>, strongly associated with HIV infection <xref rid="jve5-bib-0004" ref-type="bibr">[4–6]</xref>. CMV is also a probable cause of meningitis and gastrointestinal infection in African children, with or without accompanying bacterial infection <xref rid="jve5-bib-0007" ref-type="bibr">[7,73]</xref>, but routine diagnosis and treatment is broadly unavailable.</p></sec><sec id="jve5-sec-0004"><title id="jve5-title-0005">CMV and HIV-infected African adults</title><p id="jve5-para-0011">Before effective antiretroviral therapy was available, 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 <xref rid="jve5-bib-0074" ref-type="bibr">[74]</xref>. However, after introduction of combination ART, CMV disease became a rare complication in this setting <xref rid="jve5-bib-0150" ref-type="bibr">[75]</xref>. In Africa, access to ART is improving <xref rid="jve5-bib-0151" ref-type="bibr">[76]</xref>, but HIV-associated tuberculosis and bacterial pneumonia continue to be leading causes of death <xref rid="jve5-bib-0073" ref-type="bibr">[72,77]</xref>. The role of CMV comorbidity in these patient groups is largely unknown, as diagnostic testing for CMV is not routinely performed.</p></sec><sec id="jve5-sec-0005"><title id="jve5-title-0006">CMV retinitis</title><p id="jve5-para-0012">Retinitis is the most common manifestation of CMV disease in HIV-infected patients in Western countries <xref rid="jve5-bib-0153" ref-type="bibr">[78]</xref>, and this has led to a body of work investigating CMV retinitis in developing countries. In a systematic review of HIV-infected individuals in in Africa (18 studies, 4325 patients), the prevalence of CMV retinitis was 2.2% (95% CI: 1.3–3.1%), significantly lower than in Asia <xref rid="jve5-bib-0154" ref-type="bibr">[79]</xref>. One reason for this difference may be lower CD4 T cell counts on starting ART in Asia compared to Africa <xref rid="jve5-bib-0155" ref-type="bibr">[80]</xref>. However, a study comparing the prevalence of CMV retinitis in India and South Africa found retinitis to be significantly less common in South Africa, even after controlling for differences in ART use <xref rid="jve5-bib-0156" ref-type="bibr">[81]</xref>. In Africa, widespread pre-existing CMV immunity from infancy may contribute to different prevalence of CMV retinitis in African adults compared to adults coming from lower CMV seroprevalence settings. It is unknown whether there are any genetic factors that might influence different levels of CMV retinitis between African and Asian populations.</p></sec><sec id="jve5-sec-0006"><title id="jve5-title-0007">CMV extraocular disease and autopsy</title><p id="jve5-para-0013">In contrast to CMV retinitis, which can be diagnosed by ophthalmoscopy, confirmatory diagnosis of extraocular CMV disease generally requires histopathological examination of biopsy or post mortem specimens, procedures that are not widely available in Africa. Whilst molecular diagnostic tests to detect CMV DNA are now commonly used in the research setting <xref rid="jve5-bib-0006" ref-type="bibr">[6,7,42]</xref>, detection of DNA in most clinical specimens does not automatically indicate disease and need for treatment and there is still insufficient data to define reliable viral load cut-offs for most patient groups <xref rid="jve5-bib-0005" ref-type="bibr">[5]</xref>.</p><p id="jve5-para-0014">Several research studies from Africa indicate that CMV may be an important pathogen in patients with suspected acute neurological disease. A study of meningitis in an HIV-Infected Ugandan cohort detected CMV in the cerebrospinal fluid (CSF) in 7% of patients, frequently in combination with other pathogens <xref rid="jve5-bib-0157" ref-type="bibr">[82]</xref>. In Malawi, CMV was detected in the CSF in 14% (2/14) of HIV-infected patients with aseptic meningitis <xref rid="jve5-bib-0158" ref-type="bibr">[83]</xref>. In this study, confirmed bacterial or fungal meningitis cases were not screened for viruses, but a later study from the same research group, found CMV in the CSF of 10% (11/115) of HIV-infected patients with bacterial meningitis <xref rid="jve5-bib-0008" ref-type="bibr">[8]</xref>. This study also showed a significant association between dual EBV/CMV infection and mortality, with dual herpesvirus infection possibly eliciting greater CSF inflammation than mono-infection. A study from a tertiary care centre in Zambia found CMV in the CSF of 6% of HIV-infected adults with symptoms suggestive of CNS opportunistic disease, frequently in combination with other pathogens <xref rid="jve5-bib-0159" ref-type="bibr">[84]</xref>. Together, these four studies indicate that CMV is detectable in the CSF of a minority of HIV-infected individuals with suspected meningitis or CNS opportunistic disease, and is associated with poor outcome. In resource-rich settings, CMV is not generally recognised as a cause of isolated meningitis in HIV-infected adults, but is established as a cause of encephalitis, myelitis, polyradiculopathy and peripheral neuropathy. However, the above studies do not reveal sufficient data to conclude whether detection of CMV DNA in the CSF is a feature of any of these diverse neurological manifestations. Imaging studies, either magnetic resonance imaging (MRI) or computer tomography (CT), have value in the diagnosis of encephalitis and myelitis, but are not affordable or available to most patients living with HIV in Africa.</p><p id="jve5-para-0015">A diagnosis of CMV disease is rarely made <italic>antemortem</italic> in poorly resourced African hospitals, as affordable diagnostics and treatment for CMV have not been developed. Even in industrialised countries, the diagnosis of CMV disease is often first made at autopsy <xref rid="jve5-bib-0160" ref-type="bibr">[85]</xref>, in which the detection of classic owl's eye inclusions is indicative of active CMV disease. However, autopsies are rarely performed in Africa, as they require infrastructure and expertise that is unavailable outside of major referral hospitals <xref rid="jve5-bib-0072" ref-type="bibr">[72]</xref>. In addition, there is also strong cultural opposition to mutilation of the deceased <xref rid="jve5-bib-0161" ref-type="bibr">[86]</xref>. A review of African autopsy studies from 2010 identified nine complete autopsy studies that included HIV-infected cadavers, and found CMV disease in 4–18% of these <xref rid="jve5-bib-0162" ref-type="bibr">[87]</xref>. A similar review focusing on lung pathology gave a pooled prevalence of 7.5% (68/902) for CMV pneumonitis in HIV-infected adult cadavers <xref rid="jve5-bib-0072" ref-type="bibr">[72]</xref>. An autopsy study from Cote d’Ivoire (pre-ART) found CMV disease to be the cause of death in 2% of patients with HIV-1 compared with 18% of patients with HIV-2, possibly because of longer survival with a low CD4 cell count in HIV-2-infected individuals <xref rid="jve5-bib-0163" ref-type="bibr">[88]</xref>.</p><p id="jve5-para-0016">A study from South Africa among HIV-infected ART-naïve gold miners found that mortality increased with higher CMV DNAemia (>1000 copies/mL <italic>vs</italic> no viraemia) with an adjusted hazard ratio of 3.7 <xref rid="jve5-bib-0164" ref-type="bibr">[89]</xref>. An association between CMV DNAemia and risk of dying was also found in a study from Tanzania among adults initiating ART, where baseline CMV DNAemia (>200 copies/mL in dried blood spots) was an independent risk factor for death with an adjusted hazard ratio of 5.0 <xref rid="jve5-bib-0042" ref-type="bibr">[42]</xref>. Among South African patients in intensive care, CMV DNAemia (>1000 copies/mL) was associated with a greater risk of mortality (hazard ratio: 3.5) <xref rid="jve5-bib-0011" ref-type="bibr">[11]</xref>.</p></sec><sec id="jve5-sec-0007"><title id="jve5-title-0008">CMV in non-HIV-infected immunosuppressed adults</title><p id="jve5-para-0017">CMV may reactivate and cause severe disease after solid organ and bone marrow transplantation <xref rid="jve5-bib-0165" ref-type="bibr">[90,91]</xref>. Organ transplantation is a rare procedure in most African countries, but in general CMV represents a similar challenge to that in most other countries, except that CMV mismatch is less common due to high seroprevalence in the population <xref rid="jve5-bib-0165" ref-type="bibr">[90,91]</xref>. Patients with inflammatory bowel disease (IBD) are also at risk of complications from CMV infection <xref rid="jve5-bib-0167" ref-type="bibr">[92]</xref>. In a study from Egypt, evidence of CMV disease was found in 35% of cases with steroid refractory colitis <xref rid="jve5-bib-0168" ref-type="bibr">[93]</xref>. This indicates that 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.</p></sec><sec id="jve5-sec-0008"><title id="jve5-title-0009">Diagnostic and therapeutic challenges</title><p id="jve5-para-0018">Globally, CMV DNA appears to be a biomarker of morbidity and mortality in a range of patient groups <xref rid="jve5-bib-0169" ref-type="bibr">[94]</xref>, and this has also been found in Africa. Uncontrolled data from South Africa indicate that for severely ill patients ganciclovir therapy could be life-saving <xref rid="jve5-bib-0004" ref-type="bibr">[4,11]</xref>, yet to date there have be no randomised controlled trials of anti-CMV drugs in Africa. Of critical importance is the high cost of ganciclovir and valganciclovir, and the perception that competing priorities are more important. The development of new <xref rid="jve5-bib-0170" ref-type="bibr">[95]</xref> or cheaper generic CMV drugs and repurposing of available medicines <xref rid="jve5-bib-0171" ref-type="bibr">[96]</xref> are steps in the right direction, but treatment will only become more available to low-income patient groups if trials are undertaken and if they demonstrate sufficient impact. When designing therapeutic trials for CMV, the method of diagnosis, and even the definition of CMV disease, present several challenges. The traditional gold standard of histopathological observation of ‘owl's eye’ inclusions in diseased tissue requires invasive sampling (e.g. pulmonary or gastrointestinal biopsy), and is an unlikely criterion for use in clinical trials in Africa. Culture techniques have been used to study CMV in Africa, from urine, saliva or respiratory specimens <xref rid="jve5-bib-0005" ref-type="bibr">[5,56]</xref>, but more recent studies have used molecular diagnostics. Large-scale investment in HIV and TB programmes, along with other research activities, means that PCR platforms are widely available at large teaching hospitals across Africa, the most probable sites for anti-CMV drug trials. Standardised commercial CMV PCR assays offer a quantitative measure of the CMV load, facilitating reliable inter-site and inter-study comparisons. In South Africa, intravenous ganciclovir is used at several centres to treat infants with culture- or PCR-confirmed CMV pneumonitis <xref rid="jve5-bib-0004" ref-type="bibr">[4–6]</xref>, but decisions are consultant-led and dosing informed by studies from Western countries in transplant patients. Ganciclovir is associated with a range of haematological adverse events, especially neutropenia, and could be toxic in young infants with fragile immune systems. Some researchers have proposed diagnosing CMV in community-based studies, such as those designed to investigate interactions between cCMV and early infant CMV infections and developmental outcomes or vertical transmission of HIV. Several groups have explored the use of dried blood spots (DBS), which can be easily stored and transported to research centres for CMV analysis <xref rid="jve5-bib-0042" ref-type="bibr">[42,97,98]</xref>.</p></sec><sec id="jve5-sec-0009"><title id="jve5-title-0010">Immunology</title><p id="jve5-para-0019">CMV is highly immunogenic and, more than the other human herpesviruses, appears to be inextricably linked to the ageing of the immune system. Establishment of chronic CMV infection leads to a clonal expansion of differentiated CMV-specific CD8+ T cells, which in older adults can account for up to 20% of the T cell repertoire <xref rid="jve5-bib-0174" ref-type="bibr">[99]</xref>. Due to the dominance of CMV as a target for cell-mediated immunity, and the fact that primary CMV infection is ubiquitous in African children, some researchers have sought to study T cell responses to CMV, to gain insight into the development of immunity in African infants that might inform on vaccination strategies. Seminal studies from the Gambia used tetramer staining to show that even in young infants, primary CMV infection was followed by a rapid clonal expansion of differentiated CMV-specific CD8+ T cells <xref rid="jve5-bib-0175" ref-type="bibr">[100]</xref>, which persisted for at least 2 years after primary infection <xref rid="jve5-bib-0057" ref-type="bibr">[57]</xref>. Even the overall CD8+ T cell population (which could have included T cells for other CMV antigens) acquired the same differentiated phenotype after CMV primary infection <xref rid="jve5-bib-0175" ref-type="bibr">[100]</xref>. Conversely, CMV-specific CD4+ T cell responses do not appear to be so important for the control of CMV infection in the same infant population <xref rid="jve5-bib-0057" ref-type="bibr">[57]</xref>. A study from Malawi compared CD4+ and CD8+ T cell phenotypes between HIV-1-negative Malawian and UK teenagers. All (<italic>n</italic>=59) Malawian participants were CMV IgG seropositive, compared with 36% (21/58) of UK teenagers. Malawian teenagers had a lower proportion of naïve T cells and a higher proportion of memory T cells compared with age-matched UK teenagers. Similarly, within the UK teenagers, those who were CMV seropositive had reduced proportions of naïve and increased memory T cells <xref rid="jve5-bib-0176" ref-type="bibr">[101]</xref>. CMV appears to be a driving component of this earlier ageing of the immune system in African children, within the context of higher exposure to a range of pathogens in high disease-burden settings.</p><p id="jve5-para-0020">A study that included adults and children from Tanzania replicated some of these findings, and also showed that among adults, increased IFN-γ and MIP-1β production by CMV-specific CD4+ T cells was linked independently to active TB infection <xref rid="jve5-bib-0177" ref-type="bibr">[102]</xref>. There are strong parallels between CMV and TB: They both establish life-long latency, both reactivate upon immune suppression, both cause acute disease in a broad range of tissues, and both are associated with immune reconstitution inflammatory syndrome (IRIS) in patients initiating ART <xref rid="jve5-bib-0178" ref-type="bibr">[103]</xref>. A recent study in HIV-infected adults from South Africa found that after ART, the recovery of pathogen-specific T cells is relative to their memory phenotype before treatment: for example, TB-specific T cells (which are generally less differentiated) have a higher replenishment capacity than those for CMV (which are generally more differentiated) <xref rid="jve5-bib-0179" ref-type="bibr">[104]</xref>.</p></sec><sec id="jve5-sec-0010"><title id="jve5-title-0011">Conclusions</title><p id="jve5-para-0021">CMV is emerging as an important pathogen in African populations, both as an acute cause of disease, and also as a more general marker for poor outcomes, in children and immunosuppressed patients. There is a need for greater implementation of diagnostic tests and clinical trials for treatment of acute CMV disease in patient groups such as HIV-infected or exposed children with CMV pneumonia, and in HIV-infected adults with evidence of active CMV infection or disease. Furthermore, for a range of clinical trials, vaccination and immunology studies focused on African patients with HIV or TB, investigators should consider the possible confounding effects of CMV infection and incorporate viral load testing into their protocols if appropriate.</p></sec></body><back><ref-list id="jve5-ref-0001"><title>References</title><ref id="jve5-bib-0001"><label>1.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Manicklal</surname><given-names>S</given-names></name>,
<name name-style="western"><surname>Emery</surname><given-names>VC</given-names></name>,
<name name-style="western"><surname>Lazzarotto</surname><given-names>T</given-names></name><etal>et al.</etal></person-group><article-title>The “silent” global burden of congenital cytomegalovirus</article-title>.
<source>Clin Microbiol Rev</source><year>2013</year>;
<volume>26</volume>:
<fpage>86</fpage>–
<lpage>102</lpage>.<pub-id pub-id-type="pmid">23297260</pub-id></mixed-citation></ref><ref id="jve5-bib-0002"><label>2.</label><mixed-citation publication-type="book"><person-group person-group-type="author"><name name-style="western"><surname>Bates</surname><given-names>M</given-names></name>,
<name name-style="western"><surname>Musonda</surname><given-names>K</given-names></name>,
<name name-style="western"><surname>Zumla</surname><given-names>A</given-names></name></person-group><chapter-title>Human cytomegalovirus (HCMV) infection in sub-Saharan Africa</chapter-title> In:
<person-group person-group-type="editor"><name name-style="western"><surname>Price</surname><given-names>P</given-names></name></person-group> (ed.)
<source>Manifestations of Cytomegalovirus Infection</source>,
<comment>Intech Open</comment>,
<year>2013</year>:
<fpage>17</fpage>–
<lpage>39</lpage>.</mixed-citation></ref><ref id="jve5-bib-0003"><label>3.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Lanzieri</surname><given-names>TM</given-names></name>,
<name name-style="western"><surname>Dollard</surname><given-names>SC</given-names></name>,
<name name-style="western"><surname>Bialek</surname><given-names>SR</given-names></name>,
<name name-style="western"><surname>Grosse</surname><given-names>SD</given-names></name></person-group><article-title>Systematic review of the birth prevalence of congenital cytomegalovirus infection in developing countries</article-title>.
<source>Int J Infect Dis</source><year>2014</year>;
<volume>22</volume>:
<fpage>44</fpage>–
<lpage>48</lpage>.<pub-id pub-id-type="pmid">24631522</pub-id></mixed-citation></ref><ref id="jve5-bib-0004"><label>4.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Goussard</surname><given-names>P</given-names></name>,
<name name-style="western"><surname>Kling</surname><given-names>S</given-names></name>,
<name name-style="western"><surname>Gie</surname><given-names>RP</given-names></name><etal>et al.</etal></person-group><article-title>CMV pneumonia in HIV-infected ventilated infants</article-title>.
<source>Pediatr Pulmonol</source><year>2010</year>;
<volume>45</volume>:
<fpage>650</fpage>–
<lpage>655</lpage>.<pub-id pub-id-type="pmid">20575098</pub-id></mixed-citation></ref><ref id="jve5-bib-0005"><label>5.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Hsiao</surname><given-names>NY</given-names></name>,
<name name-style="western"><surname>Zampoli</surname><given-names>M</given-names></name>,
<name name-style="western"><surname>Morrow</surname><given-names>B</given-names></name><etal>et al.</etal></person-group><article-title>Cytomegalovirus viraemia in HIV exposed and infected infants: prevalence and clinical utility for diagnosing CMV pneumonia</article-title>.
<source>J Clin Virol</source><year>2013</year>;
<volume>58</volume>:
<fpage>74</fpage>–
<lpage>78</lpage>.<pub-id pub-id-type="pmid">23727304</pub-id></mixed-citation></ref><ref id="jve5-bib-0006"><label>6.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Zampoli</surname><given-names>M</given-names></name>,
<name name-style="western"><surname>Morrow</surname><given-names>B</given-names></name>,
<name name-style="western"><surname>Hsiao</surname><given-names>NY</given-names></name><etal>et al.</etal></person-group><article-title>Prevalence and outcome of cytomegalovirus-associated pneumonia in relation to human immunodeficiency virus infection</article-title>.
<source>Pediatr Infect Dis J</source><year>2011</year>;
<volume>30</volume>:
<fpage>413</fpage>–
<lpage>417</lpage>.<pub-id pub-id-type="pmid">21150691</pub-id></mixed-citation></ref><ref id="jve5-bib-0007"><label>7.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Tembo</surname><given-names>J</given-names></name>,
<name name-style="western"><surname>Kabwe</surname><given-names>M</given-names></name>,
<name name-style="western"><surname>Chilukutu</surname><given-names>L</given-names></name><etal>et al.</etal></person-group><article-title>Prevalence and risk factors for betaherpesvirus DNAemia in children >3 weeks and <2 years of age admitted to a large referral hospital in sub-Saharan Africa</article-title>.
<source>Clin Infect Dis</source><year>2015</year>;
<volume>60</volume>:
<fpage>423</fpage>–
<lpage>431</lpage>.<pub-id pub-id-type="pmid">25352585</pub-id></mixed-citation></ref><ref id="jve5-bib-0008"><label>8.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Kelly</surname><given-names>MJ</given-names></name>,
<name name-style="western"><surname>Benjamin</surname><given-names>LA</given-names></name>,
<name name-style="western"><surname>Cartwright</surname><given-names>K</given-names></name><etal>et al.</etal></person-group><article-title>Epstein-barr virus coinfection in cerebrospinal fluid is associated with increased mortality in Malawian adults with bacterial meningitis</article-title>.
<source>J Infect Dis</source><year>2012</year>;
<volume>205</volume>:
<fpage>106</fpage>–
<lpage>110</lpage>.<pub-id pub-id-type="pmid">22075766</pub-id></mixed-citation></ref><ref id="jve5-bib-0009"><label>9.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Gompels</surname><given-names>UA</given-names></name>,
<name name-style="western"><surname>Larke</surname><given-names>N</given-names></name>,
<name name-style="western"><surname>Sanz-Ramos</surname><given-names>M</given-names></name><etal>et al.</etal></person-group><article-title>Human cytomegalovirus infant infection adversely affects growth and development in maternally HIV-exposed and unexposed infants in Zambia</article-title>.
<source>Clin Infect Dis</source><year>2012</year>;
<volume>54</volume>:
<fpage>434</fpage>–
<lpage>442</lpage>.<pub-id pub-id-type="pmid">22247303</pub-id></mixed-citation></ref><ref id="jve5-bib-0010"><label>10.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Adland</surname><given-names>E</given-names></name>,
<name name-style="western"><surname>Klenerman</surname><given-names>P</given-names></name>,
<name name-style="western"><surname>Goulder</surname><given-names>P</given-names></name>,
<name name-style="western"><surname>Matthews</surname><given-names>PC</given-names></name></person-group><article-title>Ongoing burden of disease and mortality from HIV/CMV coinfection in Africa in the antiretroviral therapy era</article-title>.
<source>Front Microbiol</source><year>2015</year>;
<volume>6</volume>:
<fpage>1016</fpage>.<pub-id pub-id-type="pmid">26441939</pub-id></mixed-citation></ref><ref id="jve5-bib-0011"><label>11.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Mayaphi</surname><given-names>SH</given-names></name>,
<name name-style="western"><surname>Brauer</surname><given-names>M</given-names></name>,
<name name-style="western"><surname>Morobadi</surname><given-names>DM</given-names></name><etal>et al.</etal></person-group><article-title>Cytomegalovirus viral load kinetics in patients with HIV/AIDS admitted to a medical intensive care unit: a case for pre-emptive therapy</article-title>.
<source>PLoS One</source><year>2014</year>;
<volume>9</volume>:
<fpage>e93702</fpage>.<pub-id pub-id-type="pmid">24699683</pub-id></mixed-citation></ref><ref id="jve5-bib-0012"><label>12.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Foulon</surname><given-names>I</given-names></name>,
<name name-style="western"><surname>Naessens</surname><given-names>A</given-names></name>,
<name name-style="western"><surname>Foulon</surname><given-names>W</given-names></name><etal>et al.</etal></person-group><article-title>A 10-year prospective study of sensorineural hearing loss in children with congenital cytomegalovirus infection</article-title>.
<source>J Pediatr</source><year>2008</year>;
<volume>153</volume>:
<fpage>84</fpage>–
<lpage>88</lpage>.<pub-id pub-id-type="pmid">18571542</pub-id></mixed-citation></ref><ref id="jve5-bib-0013"><label>13.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Fowler</surname><given-names>KB</given-names></name>,
<name name-style="western"><surname>Stagno</surname><given-names>S</given-names></name>,
<name name-style="western"><surname>Pass</surname><given-names>RF</given-names></name><etal>et al.</etal></person-group><article-title>The outcome of congenital cytomegalovirus infection in relation to maternal antibody status</article-title>.
<source>N Engl J Med</source><year>1992</year>;
<volume>326</volume>:
<fpage>663</fpage>–
<lpage>667</lpage>.<pub-id pub-id-type="pmid">1310525</pub-id></mixed-citation></ref><ref id="jve5-bib-0014"><label>14.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Ross</surname><given-names>SA</given-names></name>,
<name name-style="western"><surname>Fowler</surname><given-names>KB</given-names></name>,
<name name-style="western"><surname>Ashrith</surname><given-names>G</given-names></name><etal>et al.</etal></person-group><article-title>Hearing loss in children with congenital cytomegalovirus infection born to mothers with preexisting immunity</article-title>.
<source>J Pediatr</source><year>2006</year>;
<volume>148</volume>:
<fpage>332</fpage>–
<lpage>336</lpage>.<pub-id pub-id-type="pmid">16615962</pub-id></mixed-citation></ref><ref id="jve5-bib-0015"><label>15.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Vries</surname><given-names>JJ</given-names><prefix>de</prefix></name>,
<name name-style="western"><surname>Zwet</surname><given-names>EW</given-names><prefix>van</prefix></name>,
<name name-style="western"><surname>Dekker</surname><given-names>FW</given-names></name><etal>et al.</etal></person-group><article-title>The apparent paradox of maternal seropositivity as a risk factor for congenital cytomegalovirus infection: a population-based prediction model</article-title>.
<source>Rev Med Virol</source><year>2013</year>;
<volume>23</volume>:
<fpage>241</fpage>–
<lpage>249</lpage>.<pub-id pub-id-type="pmid">23559569</pub-id></mixed-citation></ref><ref id="jve5-bib-0016"><label>16.</label><mixed-citation publication-type="other"><person-group person-group-type="author"><collab>CDC</collab></person-group><source>Revised Surveillance Case Definition for HIV Infection – United States, 2014</source>.
<comment>Atlanta, CDC</comment>,
<year>2014</year>:
<fpage>11</fpage><comment>Available at:</comment><comment><uri xlink:href="http://www.cdc.gov/mmwr/pdf/rr/rr6303.pdf">http://www.cdc.gov/mmwr/pdf/rr/rr6303.pdf</uri></comment> (
<comment>accessed June 2016</comment>)</mixed-citation></ref><ref id="jve5-bib-0017"><label>17.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Ajayi</surname><given-names>SO</given-names></name>,
<name name-style="western"><surname>Raji</surname><given-names>Y</given-names></name>,
<name name-style="western"><surname>Salako</surname><given-names>BL</given-names></name></person-group><article-title>Ethical and legal issues in renal transplantation in Nigeria</article-title>.
<source>Saudi J Kidney Dis Transpl</source><year>2016</year>;
<volume>27</volume>:
<fpage>125</fpage>–
<lpage>128</lpage>.<pub-id pub-id-type="pmid">26787578</pub-id></mixed-citation></ref><ref id="jve5-bib-0018"><label>18.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Spearman</surname><given-names>CW</given-names></name>,
<name name-style="western"><surname>McCulloch</surname><given-names>MI</given-names></name></person-group><article-title>Challenges for paediatric transplantation in Africa</article-title>.
<source>Pediatr Transplant</source><year>2014</year>;
<volume>18</volume>:
<fpage>668</fpage>–
<lpage>674</lpage>.<pub-id pub-id-type="pmid">25118070</pub-id></mixed-citation></ref><ref id="jve5-bib-0019"><label>19.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Dupont</surname><given-names>L</given-names></name>,
<name name-style="western"><surname>Reeves</surname><given-names>MB</given-names></name></person-group><article-title>Cytomegalovirus latency and reactivation: recent insights into an age old problem</article-title>.
<source>Rev Med Virol</source><year>2016</year>;
<volume>26</volume>:
<fpage>75</fpage>–
<lpage>89</lpage>.<pub-id pub-id-type="pmid">26572645</pub-id></mixed-citation></ref><ref id="jve5-bib-0020"><label>20.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Mussi-Pinhata</surname><given-names>MM</given-names></name>,
<name name-style="western"><surname>Yamamoto</surname><given-names>AY</given-names></name>,
<name name-style="western"><surname>Moura Brito</surname><given-names>RM</given-names></name><etal>et al.</etal></person-group><article-title>Birth prevalence and natural history of congenital cytomegalovirus infection in a highly seroimmune population</article-title>.
<source>Clin Infect Dis</source><year>2009</year>;
<volume>49</volume>:
<fpage>522</fpage>–
<lpage>528</lpage>.<pub-id pub-id-type="pmid">19583520</pub-id></mixed-citation></ref><ref id="jve5-bib-0021"><label>21.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Yamamoto</surname><given-names>AY</given-names></name>,
<name name-style="western"><surname>Mussi-Pinhata</surname><given-names>MM</given-names></name>,
<name name-style="western"><surname>Boppana</surname><given-names>SB</given-names></name><etal>et al.</etal></person-group><article-title>Human cytomegalovirus reinfection is associated with intrauterine transmission in a highly cytomegalovirus-immune maternal population</article-title>.
<source>Am J Obstet Gynecol</source><year>2010</year>;
<volume>202</volume>:
<issue>297</issue><fpage>e291</fpage>–
<lpage>298</lpage>.</mixed-citation></ref><ref id="jve5-bib-0022"><label>22.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Yamamoto</surname><given-names>AY</given-names></name>,
<name name-style="western"><surname>Mussi-Pinhata</surname><given-names>MM</given-names></name>,
<name name-style="western"><surname>Isaac Mde</surname><given-names>L</given-names></name><etal>et al.</etal></person-group><article-title>Congenital cytomegalovirus infection as a cause of sensorineural hearing loss in a highly immune population</article-title>.
<source>Pediatr Infect Dis J</source><year>2011</year>;
<volume>30</volume>:
<fpage>1043</fpage>–
<lpage>1046</lpage>.<pub-id pub-id-type="pmid">21814153</pub-id></mixed-citation></ref><ref id="jve5-bib-0023"><label>23.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Staras</surname><given-names>SA</given-names></name>,
<name name-style="western"><surname>Dollard</surname><given-names>SC</given-names></name>,
<name name-style="western"><surname>Radford</surname><given-names>KW</given-names></name><etal>et al.</etal></person-group><article-title>Seroprevalence of cytomegalovirus infection in the United States, 1988–1994</article-title>.
<source>Clin Infect Dis</source><year>2006</year>;
<volume>43</volume>:
<fpage>1143</fpage>–
<lpage>1151</lpage>.<pub-id pub-id-type="pmid">17029132</pub-id></mixed-citation></ref><ref id="jve5-bib-0024"><label>24.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Ahlfors</surname><given-names>K</given-names></name>,
<name name-style="western"><surname>Ivarsson</surname><given-names>SA</given-names></name>,
<name name-style="western"><surname>Johnsson</surname><given-names>T</given-names></name>,
<name name-style="western"><surname>Svanberg</surname><given-names>L</given-names></name></person-group><article-title>Primary and secondary maternal cytomegalovirus infections and their relation to congenital infection. Analysis of maternal sera</article-title>.
<source>Acta Paediatr Scand</source><year>1982</year>;
<volume>71</volume>:
<fpage>109</fpage>–
<lpage>113</lpage>.<pub-id pub-id-type="pmid">6291314</pub-id></mixed-citation></ref><ref id="jve5-bib-0025"><label>25.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Numazaki</surname><given-names>K</given-names></name>,
<name name-style="western"><surname>Fujikawa</surname><given-names>T</given-names></name>,
<name name-style="western"><surname>Chiba</surname><given-names>S</given-names></name></person-group><article-title>Relationship between seropositivity of husbands and primary cytomegalovirus infection during pregnancy</article-title>.
<source>J Infect Chemother</source><year>2000</year>;
<volume>6</volume>:
<fpage>104</fpage>–
<lpage>106</lpage>.<pub-id pub-id-type="pmid">11810545</pub-id></mixed-citation></ref><ref id="jve5-bib-0026"><label>26.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Shigemi</surname><given-names>D</given-names></name>,
<name name-style="western"><surname>Yamaguchi</surname><given-names>S</given-names></name>,
<name name-style="western"><surname>Otsuka</surname><given-names>T</given-names></name><etal>et al.</etal></person-group><article-title>Seroprevalence of cytomegalovirus IgG antibodies among pregnant women in Japan from 2009–2014</article-title>.
<source>Am J Infect Control</source><year>2015</year>;
<volume>43</volume>:
<fpage>1218</fpage>–
<lpage>1221</lpage>.<pub-id pub-id-type="pmid">26277571</pub-id></mixed-citation></ref><ref id="jve5-bib-0027"><label>27.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Cannon</surname><given-names>MJ</given-names></name>,
<name name-style="western"><surname>Schmid</surname><given-names>DS</given-names></name>,
<name name-style="western"><surname>Hyde</surname><given-names>TB</given-names></name></person-group><article-title>Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection</article-title>.
<source>Rev Med Virol</source><year>2010</year>;
<volume>20</volume>:
<fpage>202</fpage>–
<lpage>213</lpage>.<pub-id pub-id-type="pmid">20564615</pub-id></mixed-citation></ref><ref id="jve5-bib-0028"><label>28.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Green</surname><given-names>MS</given-names></name>,
<name name-style="western"><surname>Cohen</surname><given-names>D</given-names></name>,
<name name-style="western"><surname>Slepon</surname><given-names>R</given-names></name><etal>et al.</etal></person-group><article-title>Ethnic and gender differences in the prevalence of anti-cytomegalovirus antibodies among young adults in Israel</article-title>.
<source>Int J Epidemiol</source><year>1993</year>;
<volume>22</volume>:
<fpage>720</fpage>–
<lpage>723</lpage>.<pub-id pub-id-type="pmid">7693603</pub-id></mixed-citation></ref><ref id="jve5-bib-0029"><label>29.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Kaur</surname><given-names>A</given-names></name>,
<name name-style="western"><surname>Kassis</surname><given-names>N</given-names></name>,
<name name-style="western"><surname>Hale</surname><given-names>CL</given-names></name><etal>et al.</etal></person-group><article-title>Direct relationship between suppression of virus-specific immunity and emergence of cytomegalovirus disease in simian AIDS</article-title>.
<source>J Virol</source><year>2003</year>;
<volume>77</volume>:
<fpage>5749</fpage>–
<lpage>5758</lpage>.<pub-id pub-id-type="pmid">12719568</pub-id></mixed-citation></ref><ref id="jve5-bib-0030"><label>30.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Olaleye</surname><given-names>OD</given-names></name>,
<name name-style="western"><surname>Omilabu</surname><given-names>SA</given-names></name>,
<name name-style="western"><surname>Baba</surname><given-names>SS</given-names></name></person-group><article-title>Cytomegalovirus infection among tuberculosis patients in a chest hospital in Nigeria</article-title>.
<source>Comp Immunol Microbiol Infect Dis</source><year>1990</year>;
<volume>13</volume>:
<fpage>101</fpage>–
<lpage>106</lpage>.<pub-id pub-id-type="pmid">2170073</pub-id></mixed-citation></ref><ref id="jve5-bib-0031"><label>31.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Maiga</surname><given-names>II</given-names></name>,
<name name-style="western"><surname>Tounkara</surname><given-names>A</given-names></name>,
<name name-style="western"><surname>Coulibaly</surname><given-names>G</given-names></name>,
<name name-style="western"><surname>Kouriba</surname><given-names>B</given-names></name></person-group><article-title>Seroprevalence of the human cytomegalovirus among blood donors and AIDS patients in Bamako</article-title>.
<source>Sante</source><year>2003</year>;
<volume>13</volume>:
<fpage>117</fpage>–
<lpage>119</lpage>.<pub-id pub-id-type="pmid">14530125</pub-id></mixed-citation></ref><ref id="jve5-bib-0032"><label>32.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Mhalu</surname><given-names>F</given-names></name>,
<name name-style="western"><surname>Haukenes</surname><given-names>G</given-names></name></person-group><article-title>Prevalence of cytomegalovirus antibody in pregnant women, AIDS patients and STD patients in Dar es Salaam</article-title>.
<source>AIDS</source><year>1990</year>;
<volume>4</volume>:
<fpage>1294</fpage>–
<lpage>1295</lpage>.<pub-id pub-id-type="pmid">1965127</pub-id></mixed-citation></ref><ref id="jve5-bib-0033"><label>33.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Adjei</surname><given-names>AA</given-names></name>,
<name name-style="western"><surname>Armah</surname><given-names>HB</given-names></name>,
<name name-style="western"><surname>Gbagbo</surname><given-names>F</given-names></name><etal>et al.</etal></person-group><article-title>Seroprevalence of HHV-8, CMV, and EBV among the general population in Ghana, West Africa</article-title>.
<source>BMC Infect Dis</source><year>2008</year>;
<volume>8</volume>:
<fpage>111</fpage>.<pub-id pub-id-type="pmid">18706107</pub-id></mixed-citation></ref><ref id="jve5-bib-0034"><label>34.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Ledru</surname><given-names>E</given-names></name>,
<name name-style="western"><surname>Diagbouga</surname><given-names>S</given-names></name>,
<name name-style="western"><surname>Ledru</surname><given-names>S</given-names></name><etal>et al.</etal></person-group><article-title>A study of Toxoplasma and Cytomegalovirus serology in tuberculosis and in HIV-infected patients in Burkina Faso</article-title>.
<source>Acta tropica</source><year>1995</year>;
<volume>59</volume>:
<fpage>149</fpage>–
<lpage>154</lpage>.<pub-id pub-id-type="pmid">7676906</pub-id></mixed-citation></ref><ref id="jve5-bib-0035"><label>35.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Compston</surname><given-names>LI</given-names></name>,
<name name-style="western"><surname>Li</surname><given-names>C</given-names></name>,
<name name-style="western"><surname>Sarkodie</surname><given-names>F</given-names></name><etal>et al.</etal></person-group><article-title>Prevalence of persistent and latent viruses in untreated patients infected with HIV-1 from Ghana, West Africa</article-title>.
<source>J Med Virol</source><year>2009</year>;
<volume>81</volume>:
<fpage>1860</fpage>–
<lpage>1868</lpage>.<pub-id pub-id-type="pmid">19774687</pub-id></mixed-citation></ref><ref id="jve5-bib-0036"><label>36.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Ismail</surname><given-names>SO</given-names></name>,
<name name-style="western"><surname>Ahmed</surname><given-names>HJ</given-names></name>,
<name name-style="western"><surname>Grillner</surname><given-names>L</given-names></name><etal>et al.</etal></person-group><article-title>Sexually transmitted diseases in men in Mogadishu, Somalia</article-title>.
<source>Int J STD AIDS</source><year>1990</year>;
<volume>1</volume>:
<fpage>102</fpage>–
<lpage>106</lpage>.<pub-id pub-id-type="pmid">1965490</pub-id></mixed-citation></ref><ref id="jve5-bib-0037"><label>37.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Njeru</surname><given-names>DG</given-names></name>,
<name name-style="western"><surname>Mwanda</surname><given-names>WO</given-names></name>,
<name name-style="western"><surname>Kitonyi</surname><given-names>GW</given-names></name>,
<name name-style="western"><surname>Njagi</surname><given-names>EC</given-names></name></person-group><article-title>Prevalence of cytomegalovirus antibodies in blood donors at the National Blood Transfusion Centre, Nairobi</article-title>.
<source>East Afr Med J</source><year>2009</year>;
<volume>86</volume>:
<fpage>S58</fpage>–
<lpage>61</lpage>.<pub-id pub-id-type="pmid">21591511</pub-id></mixed-citation></ref><ref id="jve5-bib-0038"><label>38.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Hannachi</surname><given-names>N</given-names></name>,
<name name-style="western"><surname>Boughammoura</surname><given-names>L</given-names></name>,
<name name-style="western"><surname>Marzouk</surname><given-names>M</given-names></name><etal>et al.</etal></person-group><article-title>Viral infection risk in polytransfused adults: seroprevalence of seven viruses in central Tunisia</article-title>.
<source>Bull Soc Pathol Exot</source><year>2011</year>;
<volume>104</volume>:
<fpage>220</fpage>–
<lpage>225</lpage>.<pub-id pub-id-type="pmid">21695497</pub-id></mixed-citation></ref><ref id="jve5-bib-0039"><label>39.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Gargouri</surname><given-names>J</given-names></name>,
<name name-style="western"><surname>Elleuch</surname><given-names>H</given-names></name>,
<name name-style="western"><surname>Karray</surname><given-names>H</given-names></name><etal>et al.</etal></person-group><article-title>Prevalence of anti-CMV antibodies in blood donors in the Sfax region (value in blood transfusion)</article-title>.
<source>Tunis Med</source><year>2000</year>;
<volume>78</volume>:
<fpage>512</fpage>–
<lpage>517</lpage>.<pub-id pub-id-type="pmid">11190729</pub-id></mixed-citation></ref><ref id="jve5-bib-0040"><label>40.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Wester</surname><given-names>CW</given-names></name>,
<name name-style="western"><surname>Bussmann</surname><given-names>H</given-names></name>,
<name name-style="western"><surname>Moyo</surname><given-names>S</given-names></name><etal>et al.</etal></person-group><article-title>Serological evidence of HIV-associated infection among HIV-1-infected adults in Botswana</article-title>.
<source>Clin Infect Dis</source><year>2006</year>;
<volume>43</volume>:
<fpage>1612</fpage>–
<lpage>1615</lpage>.<pub-id pub-id-type="pmid">17109297</pub-id></mixed-citation></ref><ref id="jve5-bib-0041"><label>41.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Schaftenaar</surname><given-names>E</given-names></name>,
<name name-style="western"><surname>Verjans</surname><given-names>GM</given-names></name>,
<name name-style="western"><surname>Getu</surname><given-names>S</given-names></name><etal>et al.</etal></person-group><article-title>High seroprevalence of human herpesviruses in HIV-infected individuals attending primary healthcare facilities in rural South Africa</article-title>.
<source>PLoS One</source><year>2014</year>;
<volume>9</volume>:
<fpage>e99243</fpage>.<pub-id pub-id-type="pmid">24914671</pub-id></mixed-citation></ref><ref id="jve5-bib-0042"><label>42.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Brantsaeter</surname><given-names>AB</given-names></name>,
<name name-style="western"><surname>Johannessen</surname><given-names>A</given-names></name>,
<name name-style="western"><surname>Holberg-Petersen</surname><given-names>M</given-names></name><etal>et al.</etal></person-group><article-title>Cytomegalovirus viremia in dried blood spots is associated with an increased risk of death in HIV-infected patients: a cohort study from rural Tanzania</article-title>.
<source>Int J Infect Dis</source><year>2012</year>;
<volume>16</volume>:
<fpage>e879</fpage>–
<lpage>885</lpage>.<pub-id pub-id-type="pmid">23031419</pub-id></mixed-citation></ref><ref id="jve5-bib-0043"><label>43.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Rabenau</surname><given-names>HF</given-names></name>,
<name name-style="western"><surname>Lennemann</surname><given-names>T</given-names></name>,
<name name-style="western"><surname>Kircher</surname><given-names>C</given-names></name><etal>et al.</etal></person-group><article-title>Prevalence- and gender-specific immune response to opportunistic infections in HIV-infected patients in Lesotho</article-title>.
<source>Sex Transm Dis</source><year>2010</year>;
<volume>37</volume>:
<fpage>454</fpage>–
<lpage>459</lpage>.<pub-id pub-id-type="pmid">20531031</pub-id></mixed-citation></ref><ref id="jve5-bib-0044"><label>44.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Fowotade</surname><given-names>A</given-names></name>,
<name name-style="western"><surname>Okonko</surname><given-names>IO</given-names></name>,
<name name-style="western"><surname>Agbede</surname><given-names>OO</given-names></name>,
<name name-style="western"><surname>Suleiman</surname><given-names>ST</given-names></name></person-group><article-title>High seropositivity of IgG and IgM antibodies against cytomegalovirus (CMV) among HIV-1 seropositive patients in Ilorin, Nigeria</article-title>.
<source>Afr Health Sci</source><year>2015</year>;
<volume>15</volume>:
<fpage>1</fpage>–
<lpage>9</lpage>.<pub-id pub-id-type="pmid">25834524</pub-id></mixed-citation></ref><ref id="jve5-bib-0045"><label>45.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Rodier</surname><given-names>MH</given-names></name>,
<name name-style="western"><surname>Berthonneau</surname><given-names>J</given-names></name>,
<name name-style="western"><surname>Bourgoin</surname><given-names>A</given-names></name><etal>et al.</etal></person-group><article-title>Seroprevalences of Toxoplasma, malaria, rubella, cytomegalovirus, HIV and treponemal infections among pregnant women in Cotonou, Republic of Benin</article-title>.
<source>Acta Trop</source><year>1995</year>;
<volume>59</volume>:
<fpage>271</fpage>–
<lpage>277</lpage>.<pub-id pub-id-type="pmid">8533662</pub-id></mixed-citation></ref><ref id="jve5-bib-0046"><label>46.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Williams</surname><given-names>JO</given-names></name>,
<name name-style="western"><surname>Fagbami</surname><given-names>AH</given-names></name>,
<name name-style="western"><surname>Omilabu</surname><given-names>SA</given-names></name></person-group><article-title>Cytomegalovirus antibodies in Nigeria</article-title>.
<source>Trans R Soc Trop Med Hyg</source><year>1989</year>;
<volume>83</volume>:
<fpage>260</fpage>.<pub-id pub-id-type="pmid">2558435</pub-id></mixed-citation></ref><ref id="jve5-bib-0047"><label>47.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Hamid</surname><given-names>KM</given-names></name>,
<name name-style="western"><surname>Onoja</surname><given-names>AB</given-names></name>,
<name name-style="western"><surname>Tofa</surname><given-names>UA</given-names></name>,
<name name-style="western"><surname>Garba</surname><given-names>KN</given-names></name></person-group><article-title>Seroprevalence of cytomegalovirus among pregnant women attending Murtala Mohammed Specialist Hospital Kano, Nigeria</article-title>.
<source>Afr Health Sci</source><year>2014</year>;
<volume>14</volume>:
<fpage>125</fpage>–
<lpage>130</lpage>.<pub-id pub-id-type="pmid">26060468</pub-id></mixed-citation></ref><ref id="jve5-bib-0048"><label>48.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Schoub</surname><given-names>BD</given-names></name>,
<name name-style="western"><surname>Johnson</surname><given-names>S</given-names></name>,
<name name-style="western"><surname>McAnerney</surname><given-names>JM</given-names></name><etal>et al.</etal></person-group><article-title>Is antenatal screening for rubella and cytomegalovirus justified?</article-title><source>S Afr Med J</source><year>1993</year>;
<volume>83</volume>:
<fpage>108</fpage>–
<lpage>110</lpage>.<pub-id pub-id-type="pmid">8383882</pub-id></mixed-citation></ref><ref id="jve5-bib-0049"><label>49.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Hannachi</surname><given-names>N</given-names></name>,
<name name-style="western"><surname>Marzouk</surname><given-names>M</given-names></name>,
<name name-style="western"><surname>Harrabi</surname><given-names>I</given-names></name><etal>et al.</etal></person-group><article-title>Seroprevalence of rubella virus, varicella zoster virus, cytomegalovirus and parvovirus B19 among pregnant women in the Sousse region, Tunisia</article-title>.
<source>Bull Soc Pathol Exot</source><year>2011</year>;
<volume>104</volume>:
<fpage>62</fpage>–
<lpage>67</lpage>.<pub-id pub-id-type="pmid">21243459</pub-id></mixed-citation></ref><ref id="jve5-bib-0050"><label>50.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Hamdan</surname><given-names>HZ</given-names></name>,
<name name-style="western"><surname>Abdelbagi</surname><given-names>IE</given-names></name>,
<name name-style="western"><surname>Nasser</surname><given-names>NM</given-names></name>,
<name name-style="western"><surname>Adam</surname><given-names>I</given-names></name></person-group><article-title>Seroprevalence of cytomegalovirus and rubella among pregnant women in western Sudan</article-title>.
<source>Virol J</source><year>2011</year>;
<volume>8</volume>:
<fpage>217</fpage>.<pub-id pub-id-type="pmid">21569321</pub-id></mixed-citation></ref><ref id="jve5-bib-0051"><label>51.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Kaye</surname><given-names>S</given-names></name>,
<name name-style="western"><surname>Miles</surname><given-names>D</given-names></name>,
<name name-style="western"><surname>Antoine</surname><given-names>P</given-names></name><etal>et al.</etal></person-group><article-title>Virological and immunological correlates of mother-to-child transmission of cytomegalovirus in The Gambia</article-title>.
<source>J Infect Dis</source><year>2008</year>;
<volume>197</volume>:
<fpage>1307</fpage>–
<lpage>1314</lpage>.<pub-id pub-id-type="pmid">18422443</pub-id></mixed-citation></ref><ref id="jve5-bib-0052"><label>52.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Maingi</surname><given-names>Z</given-names></name></person-group>,
<article-title>Nyamache AK. Seroprevalence of Cytomegalo Virus (CMV) among pregnant women in Thika, Kenya</article-title>.
<source>BMC Res Notes</source><year>2014</year>;
<volume>7</volume>:
<fpage>794</fpage>.<pub-id pub-id-type="pmid">25392013</pub-id></mixed-citation></ref><ref id="jve5-bib-0053"><label>53.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>De Paschale</surname><given-names>M</given-names></name>,
<name name-style="western"><surname>Ceriani</surname><given-names>C</given-names></name>,
<name name-style="western"><surname>Cerulli</surname><given-names>T</given-names></name><etal>et al.</etal></person-group><article-title>Antenatal screening for Toxoplasma gondii, Cytomegalovirus, rubella and Treponema pallidum infections in northern Benin</article-title>.
<source>Trop Med Int Health</source><year>2014</year>;
<volume>19</volume>:
<fpage>743</fpage>–
<lpage>746</lpage>.<pub-id pub-id-type="pmid">24612218</pub-id></mixed-citation></ref><ref id="jve5-bib-0054"><label>54.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Kamel</surname><given-names>N</given-names></name>,
<name name-style="western"><surname>Metwally</surname><given-names>L</given-names></name>,
<name name-style="western"><surname>Gomaa</surname><given-names>N</given-names></name><etal>et al.</etal></person-group><article-title>Primary cytomegalovirus infection in pregnant Egyptian women confirmed by cytomegalovirus IgG avidity testing</article-title>.
<source>Med Princ Pract</source><year>2014</year>;
<volume>23</volume>:
<fpage>29</fpage>–
<lpage>33</lpage>.<pub-id pub-id-type="pmid">24052007</pub-id></mixed-citation></ref><ref id="jve5-bib-0055"><label>55.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Stroffolini</surname><given-names>T</given-names></name>,
<name name-style="western"><surname>Ngatchu</surname><given-names>T</given-names></name>,
<name name-style="western"><surname>Chiaramonte</surname><given-names>M</given-names></name><etal>et al.</etal></person-group><article-title>Prevalence of cytomegalovirus seropositivity in an urban childhood population in Cameroon</article-title>.
<source>New Microbiol</source><year>1993</year>;
<volume>16</volume>:
<fpage>83</fpage>–
<lpage>85</lpage>.<pub-id pub-id-type="pmid">8385733</pub-id></mixed-citation></ref><ref id="jve5-bib-0056"><label>56.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Bello</surname><given-names>C</given-names></name>,
<name name-style="western"><surname>Whittle</surname><given-names>H</given-names></name></person-group><article-title>Cytomegalovirus infection in Gambian mothers and their babies</article-title>.
<source>J Clin Pathol</source><year>1991</year>;
<volume>44</volume>:
<fpage>366</fpage>–
<lpage>369</lpage>.<pub-id pub-id-type="pmid">1646236</pub-id></mixed-citation></ref><ref id="jve5-bib-0057"><label>57.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Miles</surname><given-names>DJ</given-names></name>,
<name name-style="western"><surname>Sande</surname><given-names>M</given-names><prefix>van der</prefix></name>,
<name name-style="western"><surname>Jeffries</surname><given-names>D</given-names></name><etal>et al.</etal></person-group><article-title>Maintenance of large subpopulations of differentiated CD8 T-cells two years after cytomegalovirus infection in Gambian infants</article-title>.
<source>PLoS One</source><year>2008</year>;
<volume>3</volume>:
<fpage>e2905</fpage>.<pub-id pub-id-type="pmid">18682836</pub-id></mixed-citation></ref><ref id="jve5-bib-0058"><label>58.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Bos</surname><given-names>P</given-names></name>,
<name name-style="western"><surname>Steele</surname><given-names>AD</given-names></name>,
<name name-style="western"><surname>Peenze</surname><given-names>I</given-names></name>,
<name name-style="western"><surname>Aspinall</surname><given-names>S</given-names></name></person-group><article-title>Sero-prevalence to hepatitis B and C virus infection in refugees from Mozambique in southern Africa</article-title>.
<source>East Afr Med J</source><year>1995</year>;
<volume>72</volume>:
<fpage>113</fpage>–
<lpage>115</lpage>.<pub-id pub-id-type="pmid">7796749</pub-id></mixed-citation></ref><ref id="jve5-bib-0059"><label>59.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Chakraborty</surname><given-names>R</given-names></name>,
<name name-style="western"><surname>Rees</surname><given-names>G</given-names></name>,
<name name-style="western"><surname>Bourboulia</surname><given-names>D</given-names></name><etal>et al.</etal></person-group><article-title>Viral coinfections among African children infected with human immunodeficiency virus type 1</article-title>.
<source>Clin Infect Dis</source><year>2003</year>;
<volume>36</volume>:
<fpage>922</fpage>–
<lpage>924</lpage>.<pub-id pub-id-type="pmid">12652394</pub-id></mixed-citation></ref><ref id="jve5-bib-0060"><label>60.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Loutfy</surname><given-names>SA</given-names></name>,
<name name-style="western"><surname>Alam El-Din</surname><given-names>HM</given-names></name>,
<name name-style="western"><surname>Ibrahim</surname><given-names>MF</given-names></name>,
<name name-style="western"><surname>Hafez</surname><given-names>MM</given-names></name></person-group><article-title>Seroprevalence of herpes simplex virus types 1 and 2, Epstein-Barr virus, and cytomegalovirus in children with acute lymphoblastic leukemia in Egypt</article-title>.
<source>Saudi Med J</source><year>2006</year>;
<volume>27</volume>:
<fpage>1139</fpage>–
<lpage>1145</lpage>.<pub-id pub-id-type="pmid">16883441</pub-id></mixed-citation></ref><ref id="jve5-bib-0061"><label>61.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Ghebrekidan</surname><given-names>H</given-names></name>,
<name name-style="western"><surname>Ruden</surname><given-names>U</given-names></name>,
<name name-style="western"><surname>Cox</surname><given-names>S</given-names></name><etal>et al.</etal></person-group><article-title>Prevalence of herpes simplex virus types 1 and 2, cytomegalovirus, and varicella-zoster virus infections in Eritrea</article-title>.
<source>J Clin Virol</source><year>1999</year>;
<volume>12</volume>:
<fpage>53</fpage>–
<lpage>64</lpage>.<pub-id pub-id-type="pmid">10073414</pub-id></mixed-citation></ref><ref id="jve5-bib-0062"><label>62.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Cochereau</surname><given-names>I</given-names></name>,
<name name-style="western"><surname>Mlika-Cabanne</surname><given-names>N</given-names></name>,
<name name-style="western"><surname>Godinaud</surname><given-names>P</given-names></name><etal>et al.</etal></person-group><article-title>AIDS related eye disease in Burundi, Africa</article-title>.
<source>Br J Ophthalmol</source><year>1999</year>;
<volume>83</volume>:
<fpage>339</fpage>–
<lpage>342</lpage>.<pub-id pub-id-type="pmid">10365044</pub-id></mixed-citation></ref><ref id="jve5-bib-0063"><label>63.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Taniguchi</surname><given-names>R</given-names></name>,
<name name-style="western"><surname>Koyano</surname><given-names>S</given-names></name>,
<name name-style="western"><surname>Suzutani</surname><given-names>T</given-names></name><etal>et al.</etal></person-group><article-title>A Thr72Ala polymorphism in the NKG2D gene is associated with early symptomatic congenital cytomegalovirus disease</article-title>.
<source>Infection</source><year>2015</year>;
<volume>43</volume>:
<fpage>353</fpage>–
<lpage>359</lpage>.<pub-id pub-id-type="pmid">25861030</pub-id></mixed-citation></ref><ref id="jve5-bib-0064"><label>64.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Halford</surname><given-names>WP</given-names></name>,
<name name-style="western"><surname>Balliet</surname><given-names>JW</given-names></name>,
<name name-style="western"><surname>Gebhardt</surname><given-names>BM</given-names></name></person-group><article-title>Re-evaluating natural resistance to herpes simplex virus type 1</article-title>.
<source>J Virol</source><year>2004</year>;
<volume>78</volume>:
<fpage>10086</fpage>–
<lpage>10095</lpage>.<pub-id pub-id-type="pmid">15331741</pub-id></mixed-citation></ref><ref id="jve5-bib-0065"><label>65.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Bello</surname><given-names>CS</given-names></name></person-group><article-title>Transmission of cytomegalovirus in the Gambia</article-title>.
<source>West Afr J Med</source><year>1992</year>;
<volume>11</volume>:
<fpage>140</fpage>–
<lpage>145</lpage>.<pub-id pub-id-type="pmid">1327087</pub-id></mixed-citation></ref><ref id="jve5-bib-0066"><label>66.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Manicklal</surname><given-names>S</given-names></name>,
<name name-style="western"><surname>Niekerk</surname><given-names>AM</given-names><prefix>van</prefix></name>,
<name name-style="western"><surname>Kroon</surname><given-names>SM</given-names></name><etal>et al.</etal></person-group><article-title>Birth prevalence of congenital cytomegalovirus among infants of HIV-infected women on prenatal antiretroviral prophylaxis in South Africa</article-title>.
<source>Clin Infect Dis</source><year>2014</year>;
<volume>58</volume>:
<fpage>1467</fpage>–
<lpage>1472</lpage>.<pub-id pub-id-type="pmid">24567248</pub-id></mixed-citation></ref><ref id="jve5-bib-0067"><label>67.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Sande</surname><given-names>MA</given-names><prefix>van der</prefix></name>,
<name name-style="western"><surname>Kaye</surname><given-names>S</given-names></name>,
<name name-style="western"><surname>Miles</surname><given-names>DJ</given-names></name><etal>et al.</etal></person-group><article-title>Risk factors for and clinical outcome of congenital cytomegalovirus infection in a peri-urban West-African birth cohort</article-title>.
<source>PLoS One</source><year>2007</year>;
<volume>2</volume>:
<fpage>e492</fpage>.<pub-id pub-id-type="pmid">17551573</pub-id></mixed-citation></ref><ref id="jve5-bib-0068"><label>68.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Mwaanza</surname><given-names>N</given-names></name>,
<name name-style="western"><surname>Chilukutu</surname><given-names>L</given-names></name>,
<name name-style="western"><surname>Tembo</surname><given-names>J</given-names></name><etal>et al.</etal></person-group><article-title>High rates of congenital cytomegalovirus infection linked with maternal HIV infection among neonatal admissions at a large referral center in sub-Saharan Africa</article-title>.
<source>Clin Infect Dis</source><year>2014</year>;
<volume>58</volume>:
<fpage>728</fpage>–
<lpage>735</lpage>.<pub-id pub-id-type="pmid">24265360</pub-id></mixed-citation></ref><ref id="jve5-bib-0069"><label>69.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Mwaniki</surname><given-names>MK</given-names></name>,
<name name-style="western"><surname>Atieno</surname><given-names>M</given-names></name>,
<name name-style="western"><surname>Lawn</surname><given-names>JE</given-names></name>,
<name name-style="western"><surname>Newton</surname><given-names>CR</given-names></name></person-group><article-title>Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review</article-title>.
<source>Lancet</source><year>2012</year>;
<volume>379</volume>:
<fpage>445</fpage>–
<lpage>452</lpage>.<pub-id pub-id-type="pmid">22244654</pub-id></mixed-citation></ref><ref id="jve5-bib-0070"><label>70.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Gumbo</surname><given-names>H</given-names></name>,
<name name-style="western"><surname>Chasekwa</surname><given-names>B</given-names></name>,
<name name-style="western"><surname>Church</surname><given-names>JA</given-names></name><etal>et al.</etal></person-group><article-title>Congenital and postnatal CMV and EBV acquisition in HIV-infected Zimbabwean infants</article-title>.
<source>PLoS One</source><year>2014</year>;
<volume>9</volume>:
<fpage>e114870</fpage>.<pub-id pub-id-type="pmid">25522217</pub-id></mixed-citation></ref><ref id="jve5-bib-0071"><label>71.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Slyker</surname><given-names>JA</given-names></name>,
<name name-style="western"><surname>Lohman-Payne</surname><given-names>BL</given-names></name>,
<name name-style="western"><surname>John-Stewart</surname><given-names>GC</given-names></name><etal>et al.</etal></person-group><article-title>Acute cytomegalovirus infection in Kenyan HIV-infected infants</article-title>.
<source>AIDS</source><year>2009</year>;
<volume>23</volume>:
<fpage>2173</fpage>–
<lpage>2181</lpage>.<pub-id pub-id-type="pmid">19617812</pub-id></mixed-citation></ref><ref id="jve5-bib-0072"><label>72.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Bates</surname><given-names>M</given-names></name>,
<name name-style="western"><surname>Mudenda</surname><given-names>V</given-names></name>,
<name name-style="western"><surname>Mwaba</surname><given-names>P</given-names></name>,
<name name-style="western"><surname>Zumla</surname><given-names>A</given-names></name></person-group><article-title>Deaths due to respiratory tract infections in Africa: a review of autopsy studies</article-title>.
<source>Curr Opin Pulm Med</source><year>2013</year>;
<volume>19</volume>:
<fpage>229</fpage>–
<lpage>237</lpage>.<pub-id pub-id-type="pmid">23429099</pub-id></mixed-citation></ref><ref id="jve5-bib-0073"><label>73.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Arnold</surname><given-names>M</given-names></name>,
<name name-style="western"><surname>Itzikowitz</surname><given-names>R</given-names></name>,
<name name-style="western"><surname>Young</surname><given-names>B</given-names></name><etal>et al.</etal></person-group><article-title>Surgical manifestations of gastrointestinal cytomegalovirus infection in children: Clinical audit and literature review</article-title>.
<source>J Pediatr Surg</source><year>2015</year>;
<volume>50</volume>:
<fpage>1874</fpage>–
<lpage>1879</lpage>.<pub-id pub-id-type="pmid">26265193</pub-id></mixed-citation></ref><ref id="jve5-bib-0074"><label>74.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Brantsaeter</surname><given-names>AB</given-names></name>,
<name name-style="western"><surname>Liestol</surname><given-names>K</given-names></name>,
<name name-style="western"><surname>Goplen</surname><given-names>AK</given-names></name><etal>et al.</etal></person-group><article-title>CMV disease in AIDS patients: incidence of CMV disease and relation to survival in a population-based study from Oslo</article-title>.
<source>Scand J Infect Dis</source><year>2002</year>;
<volume>34</volume>:
<fpage>50</fpage>–
<lpage>55</lpage>.<pub-id pub-id-type="pmid">11874165</pub-id></mixed-citation></ref><ref id="jve5-bib-0150"><label>75.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Yust</surname><given-names>I</given-names></name>,
<name name-style="western"><surname>Fox</surname><given-names>Z</given-names></name>,
<name name-style="western"><surname>Burke</surname><given-names>M</given-names></name><etal>et al.</etal></person-group><article-title>Retinal and extraocular cytomegalovirus end-organ disease in HIV-infected patients in Europe: a EuroSIDA study, 1994–2001</article-title>.
<source>Eur J Clin Microbiol Infect Dis</source><year>2004</year>;
<volume>23</volume>:
<fpage>550</fpage>–
<lpage>559</lpage>.<pub-id pub-id-type="pmid">15232720</pub-id></mixed-citation></ref><ref id="jve5-bib-0151"><label>76.</label><mixed-citation publication-type="other"><person-group person-group-type="author"><collab>World Health Organization</collab></person-group><source>Global update on the health sector response to HIV, 2014</source>.
<year>2014</year><comment>Available at:</comment><comment><uri xlink:href="http://www.who.int/hiv/pub/progressreports/update2014/en/">http://www.who.int/hiv/pub/progressreports/update2014/en/</uri></comment> (
<comment>accessed June 2016</comment>).</mixed-citation></ref><ref id="jve5-bib-0152"><label>77.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Bates</surname><given-names>M</given-names></name>,
<name name-style="western"><surname>Mudenda</surname><given-names>V</given-names></name>,
<name name-style="western"><surname>Shibemba</surname><given-names>A</given-names></name><etal>et al.</etal></person-group><article-title>Burden of tuberculosis at post mortem in inpatients at a tertiary referral centre in sub-Saharan Africa: a prospective descriptive autopsy study</article-title>.
<source>Lancet Infect Dis</source><year>2015</year>;
<volume>15</volume>:
<fpage>544</fpage>–
<lpage>551</lpage>.<pub-id pub-id-type="pmid">25765217</pub-id></mixed-citation></ref><ref id="jve5-bib-0153"><label>78.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Gallant</surname><given-names>JE</given-names></name>,
<name name-style="western"><surname>Moore</surname><given-names>RD</given-names></name>,
<name name-style="western"><surname>Richman</surname><given-names>DD</given-names></name><etal>et al.</etal></person-group><article-title>Incidence and natural history of cytomegalovirus disease in patients with advanced human immunodeficiency virus disease treated with zidovudine. The Zidovudine Epidemiology Study Group</article-title>.
<source>J Infect Dis</source><year>1992</year>;
<volume>166</volume>:
<fpage>1223</fpage>–
<lpage>1227</lpage>.<pub-id pub-id-type="pmid">1358986</pub-id></mixed-citation></ref><ref id="jve5-bib-0154"><label>79.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Ford</surname><given-names>N</given-names></name>,
<name name-style="western"><surname>Shubber</surname><given-names>Z</given-names></name>,
<name name-style="western"><surname>Saranchuk</surname><given-names>P</given-names></name><etal>et al.</etal></person-group><article-title>Burden of HIV-related cytomegalovirus retinitis in resource-limited settings: a systematic review</article-title>.
<source>Clin Infect Dis</source><year>2013</year>;
<volume>57</volume>:
<fpage>1351</fpage>–
<lpage>1361</lpage>.<pub-id pub-id-type="pmid">23899681</pub-id></mixed-citation></ref><ref id="jve5-bib-0155"><label>80.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Curtis</surname><given-names>AJ</given-names></name>,
<name name-style="western"><surname>Marshall</surname><given-names>CS</given-names></name>,
<name name-style="western"><surname>Spelman</surname><given-names>T</given-names></name><etal>et al.</etal></person-group><article-title>Incidence of WHO stage 3 and 4 conditions following initiation of anti-retroviral therapy in resource limited settings</article-title>.
<source>PLoS One</source><year>2012</year>;
<volume>7</volume>:
<fpage>e52019</fpage>.<pub-id pub-id-type="pmid">23284857</pub-id></mixed-citation></ref><ref id="jve5-bib-0156"><label>81.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Pathai</surname><given-names>S</given-names></name>,
<name name-style="western"><surname>Gilbert</surname><given-names>C</given-names></name>,
<name name-style="western"><surname>Weiss</surname><given-names>HA</given-names></name><etal>et al.</etal></person-group><article-title>Differing spectrum of HIV-associated ophthalmic disease among patients starting antiretroviral therapy in India and South Africa</article-title>.
<source>Trop Med Int Health</source><year>2011</year>;
<volume>16</volume>:
<fpage>356</fpage>–
<lpage>359</lpage>.<pub-id pub-id-type="pmid">21371217</pub-id></mixed-citation></ref><ref id="jve5-bib-0157"><label>82.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Rajasingham</surname><given-names>R</given-names></name>,
<name name-style="western"><surname>Rhein</surname><given-names>J</given-names></name>,
<name name-style="western"><surname>Klammer</surname><given-names>K</given-names></name><etal>et al.</etal></person-group><article-title>Epidemiology of meningitis in an HIV-infected Ugandan cohort</article-title>.
<source>Am J Trop Med Hyg</source><year>2015</year>;
<volume>92</volume>:
<fpage>274</fpage>–
<lpage>279</lpage>.<pub-id pub-id-type="pmid">25385864</pub-id></mixed-citation></ref><ref id="jve5-bib-0158"><label>83.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Benjamin</surname><given-names>LA</given-names></name>,
<name name-style="western"><surname>Kelly</surname><given-names>M</given-names></name>,
<name name-style="western"><surname>Cohen</surname><given-names>D</given-names></name><etal>et al.</etal></person-group><article-title>Detection of herpes viruses in the cerebrospinal fluid of adults with suspected viral meningitis in Malawi</article-title>.
<source>Infection</source><year>2013</year>;
<volume>41</volume>:
<fpage>27</fpage>–
<lpage>31</lpage>.<pub-id pub-id-type="pmid">22798048</pub-id></mixed-citation></ref><ref id="jve5-bib-0159"><label>84.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Siddiqi</surname><given-names>OK</given-names></name>,
<name name-style="western"><surname>Ghebremichael</surname><given-names>M</given-names></name>,
<name name-style="western"><surname>Dang</surname><given-names>X</given-names></name><etal>et al.</etal></person-group><article-title>Molecular diagnosis of central nervous system opportunistic infections in HIV-infected Zambian adults</article-title>.
<source>Clin Infect Dis</source><year>2014</year>;
<volume>58</volume>:
<fpage>1771</fpage>–
<lpage>1777</lpage>.<pub-id pub-id-type="pmid">24668125</pub-id></mixed-citation></ref><ref id="jve5-bib-0160"><label>85.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Brantsaeter</surname><given-names>AB</given-names></name>,
<name name-style="western"><surname>Liestol</surname><given-names>K</given-names></name>,
<name name-style="western"><surname>Goplen</surname><given-names>AK</given-names></name><etal>et al.</etal></person-group><article-title>CMV disease in AIDS patients: incidence of CMV disease and relation to survival in a population-based study from Oslo</article-title>.
<source>Scand J Infect Dis</source><year>2002</year>;
<volume>34</volume>:
<fpage>50</fpage>–
<lpage>55</lpage>.<pub-id pub-id-type="pmid">11874165</pub-id></mixed-citation></ref><ref id="jve5-bib-0161"><label>86.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Lishimpi</surname><given-names>K</given-names></name>,
<name name-style="western"><surname>Chintu</surname><given-names>C</given-names></name>,
<name name-style="western"><surname>Lucas</surname><given-names>S</given-names></name><etal>et al.</etal></person-group><article-title>Necropsies in African children: consent dilemmas for parents and guardians</article-title>.
<source>Arch Dis Child</source><year>2001</year>;
<volume>84</volume>:
<fpage>463</fpage>–
<lpage>467</lpage>.<pub-id pub-id-type="pmid">11369557</pub-id></mixed-citation></ref><ref id="jve5-bib-0162"><label>87.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Cox</surname><given-names>JA</given-names></name>,
<name name-style="western"><surname>Lukande</surname><given-names>RL</given-names></name>,
<name name-style="western"><surname>Lucas</surname><given-names>S</given-names></name><etal>et al.</etal></person-group><article-title>Autopsy causes of death in HIV-positive individuals in sub-Saharan Africa and correlation with clinical diagnoses</article-title>.
<source>AIDS Rev</source><year>2010</year>;
<volume>12</volume>:
<fpage>183</fpage>–
<lpage>194</lpage>.<pub-id pub-id-type="pmid">21179183</pub-id></mixed-citation></ref><ref id="jve5-bib-0163"><label>88.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Lucas</surname><given-names>SB</given-names></name>,
<name name-style="western"><surname>Hounnou</surname><given-names>A</given-names></name>,
<name name-style="western"><surname>Peacock</surname><given-names>C</given-names></name><etal>et al.</etal></person-group><article-title>The mortality and pathology of HIV infection in a west African city</article-title>.
<source>AIDS</source><year>1993</year>;
<volume>7</volume>:
<fpage>1569</fpage>–
<lpage>1579</lpage>.<pub-id pub-id-type="pmid">7904450</pub-id></mixed-citation></ref><ref id="jve5-bib-0164"><label>89.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Fielding</surname><given-names>K</given-names></name>,
<name name-style="western"><surname>Koba</surname><given-names>A</given-names></name>,
<name name-style="western"><surname>Grant</surname><given-names>AD</given-names></name><etal>et al.</etal></person-group><article-title>Cytomegalovirus viremia as a risk factor for mortality prior to antiretroviral therapy among HIV-infected gold miners in South Africa</article-title>.
<source>PLoS One</source><year>2011</year>;
<volume>6</volume>:
<fpage>e25571</fpage>.<pub-id pub-id-type="pmid">22022413</pub-id></mixed-citation></ref><ref id="jve5-bib-0165"><label>90.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Ljungman</surname><given-names>P</given-names></name></person-group><article-title>The role of cytomegalovirus serostatus on outcome of hematopoietic stem cell transplantation</article-title>.
<source>Curr Opin Hematol</source><year>2014</year>;
<volume>21</volume>:
<fpage>466</fpage>–
<lpage>469</lpage>.<pub-id pub-id-type="pmid">25159712</pub-id></mixed-citation></ref><ref id="jve5-bib-0166"><label>91.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Pereyra</surname><given-names>F</given-names></name>,
<name name-style="western"><surname>Rubin</surname><given-names>RH</given-names></name></person-group><article-title>Prevention and treatment of cytomegalovirus infection in solid organ transplant recipients</article-title>.
<source>Curr Opin Infect Dis</source><year>2004</year>;
<volume>17</volume>:
<fpage>357</fpage>–
<lpage>361</lpage>.<pub-id pub-id-type="pmid">15241082</pub-id></mixed-citation></ref><ref id="jve5-bib-0167"><label>92.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Papadakis</surname><given-names>KA</given-names></name>,
<name name-style="western"><surname>Tung</surname><given-names>JK</given-names></name>,
<name name-style="western"><surname>Binder</surname><given-names>SW</given-names></name><etal>et al.</etal></person-group><article-title>Outcome of cytomegalovirus infections in patients with inflammatory bowel disease</article-title>.
<source>Am J Gastroenterol</source><year>2001</year>;
<volume>96</volume>:
<fpage>2137</fpage>–
<lpage>2142</lpage>.<pub-id pub-id-type="pmid">11467645</pub-id></mixed-citation></ref><ref id="jve5-bib-0168"><label>93.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Maher</surname><given-names>MM</given-names></name>,
<name name-style="western"><surname>Nassar</surname><given-names>MI</given-names></name></person-group><article-title>Acute cytomegalovirus infection is a risk factor in refractory and complicated inflammatory bowel disease</article-title>.
<source>Dig Dis Sci</source><year>2009</year>;
<volume>54</volume>:
<fpage>2456</fpage>–
<lpage>2462</lpage>.<pub-id pub-id-type="pmid">19093204</pub-id></mixed-citation></ref><ref id="jve5-bib-0169"><label>94.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Deayton</surname><given-names>JR</given-names></name>,
<name name-style="western"><surname>Prof Sabin</surname><given-names>CA</given-names></name>,
<name name-style="western"><surname>Johnson</surname><given-names>MA</given-names></name><etal>et al.</etal></person-group><article-title>Importance of cytomegalovirus viraemia in risk of disease progression and death in HIV-infected patients receiving highly active antiretroviral therapy</article-title>.
<source>Lancet</source><year>2004</year>;
<volume>363</volume>:
<fpage>2116</fpage>–
<lpage>2121</lpage>.<pub-id pub-id-type="pmid">15220032</pub-id></mixed-citation></ref><ref id="jve5-bib-0170"><label>95.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Chemaly</surname><given-names>RF</given-names></name>,
<name name-style="western"><surname>Ullmann</surname><given-names>AJ</given-names></name>,
<name name-style="western"><surname>Stoelben</surname><given-names>S</given-names></name><etal>et al.</etal></person-group><article-title>Letermovir for cytomegalovirus prophylaxis in hematopoietic-cell transplantation</article-title>.
<source>N Engl J Med</source><year>2014</year>;
<volume>370</volume>:
<fpage>1781</fpage>–
<lpage>1789</lpage>.<pub-id pub-id-type="pmid">24806159</pub-id></mixed-citation></ref><ref id="jve5-bib-0171"><label>96.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Milbradt</surname><given-names>J</given-names></name>,
<name name-style="western"><surname>Auerochs</surname><given-names>S</given-names></name>,
<name name-style="western"><surname>Korn</surname><given-names>K</given-names></name>,
<name name-style="western"><surname>Marschall</surname><given-names>M</given-names></name></person-group><article-title>Sensitivity of human herpesvirus 6 and other human herpesviruses to the broad-spectrum antiinfective drug artesunate</article-title>.
<source>J Clin Virol</source><year>2009</year>;
<volume>46</volume>:
<fpage>24</fpage>–
<lpage>28</lpage>.<pub-id pub-id-type="pmid">19501020</pub-id></mixed-citation></ref><ref id="jve5-bib-0172"><label>97.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Gantt</surname><given-names>S</given-names></name>,
<name name-style="western"><surname>Huang</surname><given-names>ML</given-names></name>,
<name name-style="western"><surname>Magaret</surname><given-names>A</given-names></name><etal>et al.</etal></person-group><article-title>An artesunate-containing antimalarial treatment regimen did not suppress cytomegalovirus viremia</article-title>.
<source>J Clin Virol</source><year>2013</year>;
<volume>58</volume>:
<fpage>276</fpage>–
<lpage>278</lpage>.<pub-id pub-id-type="pmid">23827788</pub-id></mixed-citation></ref><ref id="jve5-bib-0173"><label>98.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Roxby</surname><given-names>AC</given-names></name>,
<name name-style="western"><surname>Atkinson</surname><given-names>C</given-names></name>,
<name name-style="western"><surname>Asbjornsdottir</surname><given-names>K</given-names></name><etal>et al.</etal></person-group><article-title>Maternal valacyclovir and infant cytomegalovirus acquisition: a randomized controlled trial among HIV-infected women</article-title>.
<source>PLoS One</source><year>2014</year>;
<volume>9</volume>:
<fpage>e87855</fpage>.<pub-id pub-id-type="pmid">24504006</pub-id></mixed-citation></ref><ref id="jve5-bib-0174"><label>99.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Sissons</surname><given-names>JG</given-names></name>,
<name name-style="western"><surname>Wills</surname><given-names>MR</given-names></name></person-group><article-title>How understanding immunology contributes to managing CMV disease in immunosuppressed patients: now and in future</article-title>.
<source>Med Microbiol Immunol</source><year>2015</year>;
<volume>204</volume>:
<fpage>307</fpage>–
<lpage>316</lpage>.<pub-id pub-id-type="pmid">25896527</pub-id></mixed-citation></ref><ref id="jve5-bib-0175"><label>100.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Miles</surname><given-names>DJ</given-names></name>,
<name name-style="western"><surname>Sande</surname><given-names>M</given-names><prefix>van der</prefix></name>,
<name name-style="western"><surname>Jeffries</surname><given-names>D</given-names></name><etal>et al.</etal></person-group><article-title>Cytomegalovirus infection in Gambian infants leads to profound CD8 T-cell differentiation</article-title>.
<source>J Virol</source><year>2007</year>;
<volume>81</volume>:
<fpage>5766</fpage>–
<lpage>5776</lpage>.<pub-id pub-id-type="pmid">17376923</pub-id></mixed-citation></ref><ref id="jve5-bib-0176"><label>101.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Ben-Smith</surname><given-names>A</given-names></name>,
<name name-style="western"><surname>Gorak-Stolinska</surname><given-names>P</given-names></name>,
<name name-style="western"><surname>Floyd</surname><given-names>S</given-names></name><etal>et al.</etal></person-group><article-title>Differences between naive and memory T cell phenotype in Malawian and UK adolescents: a role for Cytomegalovirus?</article-title><source>BMC Infect Dis</source><year>2008</year>;
<volume>8</volume>:
<fpage>139</fpage>.<pub-id pub-id-type="pmid">18922182</pub-id></mixed-citation></ref><ref id="jve5-bib-0177"><label>102.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Portevin</surname><given-names>D</given-names></name>,
<name name-style="western"><surname>Moukambi</surname><given-names>F</given-names></name>,
<name name-style="western"><surname>Mpina</surname><given-names>M</given-names></name><etal>et al.</etal></person-group><article-title>Maturation and Mip-1beta Production of Cytomegalovirus-Specific T Cell Responses in Tanzanian Children, Adolescents and Adults: Impact by HIV and Mycobacterium tuberculosis Co-Infections</article-title>.
<source>PLoS One</source><year>2015</year>;
<volume>10</volume>:
<fpage>e0126716</fpage>.<pub-id pub-id-type="pmid">25974183</pub-id></mixed-citation></ref><ref id="jve5-bib-0178"><label>103.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Goovaerts</surname><given-names>O</given-names></name>,
<name name-style="western"><surname>Jennes</surname><given-names>W</given-names></name>,
<name name-style="western"><surname>Massinga-Loembe</surname><given-names>M</given-names></name><etal>et al.</etal></person-group><article-title>Antigen-specific interferon-gamma responses and innate cytokine balance in TB-IRIS</article-title>.
<source>PLoS One</source><year>2014</year>;
<volume>9</volume>:
<fpage>e113101</fpage>.<pub-id pub-id-type="pmid">25415590</pub-id></mixed-citation></ref><ref id="jve5-bib-0179"><label>104.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name name-style="western"><surname>Riou</surname><given-names>C</given-names></name>,
<name name-style="western"><surname>Tanko</surname><given-names>RF</given-names></name>,
<name name-style="western"><surname>Soares</surname><given-names>AP</given-names></name><etal>et al.</etal></person-group><article-title>Restoration of CD4+ Responses to Copathogens in HIV-Infected Individuals on Antiretroviral Therapy Is Dependent on T Cell Memory Phenotype</article-title>.
<source>J Immunol</source><year>2015</year>;
<volume>195</volume>:
<fpage>2273</fpage>–
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