Cytomegalovirus Co-Infection in People with HIV on ART: Prevalence and Immunologic Correlates from a Nigerian Tertiary Hospital

Background Cytomegalovirus (CMV) is a ubiquitous herpesvirus with nearly universal seroprevalence in sub-Saharan Africa. In people living with HIV, CMV contributes to immune activation, systemic inflammation, and accelerated immune dysfunction despite virologic suppression on antiretroviral therapy (ART). Data on CMV–HIV co-infection remain scarce in North-East Nigeria, where fragile health systems and late presentation to care are common. Methods We conducted a cross-sectional study among 181 adults with confirmed HIV on ART at the Federal Teaching Hospital, Gombe. Socio-demographic and clinical data were collected using structured questionnaires and patient records. Serum samples were tested for CMV immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies by ELISA. CD4 + T-cell counts and HIV viral load were measured using flow cytometry and real-time PCR, respectively. Associations between CMV serostatus and clinical variables were assessed using Chi-square tests and logistic regression. Results All participants (100%) were CMV IgG positive, confirming universal prior exposure. CMV IgM seropositivity, indicating recent or ongoing infection, was detected in 32.1% of participants. IgM positivity occurred across all age groups and was more frequent among women, but without statistically significant associations. No significant relationship was observed between CMV IgM seropositivity and CD4 + T-cell count (p > 0.05) or HIV viral load (p > 0.05). Conclusion This study provides the first evidence of universal CMV exposure and a high prevalence of recent or reactivated infection among adults with HIV on ART in North-East Nigeria. The absence of significant associations with immunologic or virologic status in this stable cohort suggests CMV reactivation may persist independently of HIV disease markers. Further research using molecular assays is warranted to clarify CMV’s contribution to immune dysfunction and long-term ART outcomes.