Pathogenesis and seroprevalence of dengue virus in HIV-endemic regions: A global perspective

Dengue virus (DENV), a globally prevalent flavivirus, is a growing threat in regions where HIV is endemic. The co-endemicity of HIV and dengue poses overlapping clinical challenges, particularly in low-resource settings where diagnostic capacity is limited. This review examines the epidemiological overlap, immunological interactions, and diagnostic difficulties associated with DENV infection in people living with HIV (PLWH). Seroprevalence studies reveal high rates of dengue exposure among PLWH in sub-Saharan Africa, Latin America, and Southeast Asia, with increasing evidence of autochthonous transmission in non-endemic regions. Immunologically, coinfection is characterized by altered platelet function, suppressed chemokine secretion, and dysregulated T cell activation. Molecules such as CLEC5A and CD300a play key roles in the immune modulation seen in coinfected hosts. Although clinical presentations vary from mild to severe, atypical manifestations including encephalitis and hepatic dysfunction have been observed. Diagnostic confusion with acute HIV syndrome or other febrile illnesses remains a major concern. Innovations such as CRISPR-based detection systems and graphene biosensors hold promise for field-deployable diagnostics. Mathematical modeling supports integrated control strategies, and novel DENV-derived peptides like pepRF1 show potential as dual-acting therapeutics. As climate change facilitates the spread of Aedes vectors, dengue's expansion into new territories highlights the urgency of integrating arboviral surveillance with HIV care systems. This review underscores the need for enhanced diagnostics, better therapeutic options, and longitudinal research on DENV pathogenesis in immunocompromised populations.