Diagnostic test accuracy of teleretinal screening for cytomegalovirus retinitis among people living with HIV: A systematic review and meta-analysis

Cytomegalovirus retinitis (CMVR) remains a major cause of preventable blindness among people living with human immunodeficiency virus (PLHIV), particularly in resource-limited settings where access to ophthalmologists is constrained. Teleretinal screening offers a practical strategy for early detection and timely referral, with the potential to prevent irreversible visual impairment. This review aimed to determine the diagnostic accuracy of teleretinal screening for CMVR in PLHIV. It was conducted in accordance with the PRISMA diagnostic test accuracy guidelines and was registered prospectively in PROSPERO (CRD420250637110). The Cochrane Library, PubMed, CINAHL, Scopus, and Web of Science were searched on March 1, 2025. Risk of bias was assessed using the QUADAS-2 tool. Sensitivity and specificity values were pooled using the hierarchical summary receiver operating characteristic (HSROC) model, and heterogeneity was visually examined using SROC and forest plots. Subgroup analyses were performed according to country income setting, CD4 cell count thresholds, and fundus imaging modality. Quality of evidence was assessed using the GRADE framework. Five studies involving 1,460 eyes of PLHIV were included. Meta-analysis demonstrated a pooled sensitivity of 87.11% (95% confidence interval [CI]: 50.35-100%; low-certainty evidence) and a specificity of 97.73% (95% CI: 89.88-100%; high-certainty evidence). Subgroup analyses suggested higher sensitivity among populations with lower CD4 cell count thresholds. Sensitivity analysis showed no significant changes after excluding studies with a high risk of bias. Teleretinal screening for CMVR demonstrates consistently high specificity and potentially useful sensitivity. supporting its role in early detection and referral, particularly among PLHIV with advanced HIV disease. By integrating retinal imaging at the point of care with remote interpretation by ophthalmologists, teleretinal screening can expand access to eye care and reduce diagnostic delays in underserved settings. Nonetheless, further high-quality studies in diverse lower-resource settings are needed to strengthen the evidence base and guide scalable implementation within HIV care systems.