Clinical Manifestations and Diagnostic Challenges of Cytomegalovirus Infection in HIV Patients: A Case Series Study from Morocco

Abstract

Cytomegalovirus (CMV) infection is a major cause of morbidity in immunocompromised patients, particularly those living with Human Immunodeficiency Virus (HIV). This study describes the clinical manifestations, diagnostic approaches, and therapeutic challenges of CMV infection in HIV patients in Morocco. A descriptive retrospective study was conducted on seventeen (17) HIV patients with CMV infection, diagnosed by real-time Polymerase Chain Reaction (PCR). Clinical, virological (HIV and CMV viral load, CD4 count), and therapeutic data were subsequently analysed. The mean age was 43 ± 10.7 years, with male predominance (94.1%). Digestive manifestations (29.4%) were the most frequent, followed by respiratory and neurological involvement (17.6% each). The mean CD4 count was 65.4 ± 56.2 cells/mm³. The mean CMV viral load was 2.39 ± 0.74 Log and the mean HIV viral load was 4.10 ± 1.55 Log. Antiviral therapy for CMV could not be initiated in 47% of patients due to its unavailability. The outcome was favorable in 88.2% of patients, with a mortality rate of 11.8%. In conclusion; CMV infection in HIV patients in Morocco occurs in the context of severe immunosuppression and presents with a varied clinical spectrum, dominated by digestive pathologies. Real-time PCR remains crucial for diagnosis. The unavailability of antiviral drugs constitutes a major challenge for management, highlighting the need to improve access to treatments in resource-limited settings.