In sub-Saharan Africa, HCMV infection is endemic in young infants where it is linked with impaired physical and mental development, giving the infection a unique epidemiology across the region, with a potentially broad-reaching impact on the health of southern African populations. Studies conducted in sub-Saharan Africa and elsewhere, have shown that HCMV is a serious cause or morbidity and mortality, in both immunocompromised groups and congenitally infected children. In a region where 23.2 million people are living with HIV and most of the population are infected with HCMV in infancy, more prospective studies are required to better characterise the impact of HCMV in sub-Saharan Africa. This will lay the foundations for future clinical trials of anti-HCMV drugs in patient sub-sets in whom there is strong evidence that they might be effective. Drugs such as ganciclovir are already used in South Africa as life-saving treatment for HIV-infected children with severe pneumonia that is not responsive to antibiotic or anti-mycobacterial therapy. Furthermore, the clinical impact and importance of HCMV infections in sub-Saharan Africa may increase over the next decade for several reasons: Wider access to ART is resulting in increasing numbers of older HIV infected patients; Cancer incidence is forecast to increase by 32% across sub-Saharan Africa between 2010 and 2020; The number of transplant recipients is also set to increase, as the capacity of tertiary care centres develops and improves
