The diagnosis of CMVR is only possible when there are sufficient healthcare resources to prevent mortality from other opportunistic infections, such as TB and pneumocystis carinii pneumonia, which occur at higher CD4+ counts, the so-called ‘survival bias’.1,20,24 Since ART became available in 2004, HIV became a chronic disease and the prevalence of PLWH with lower CD4+ counts increased, as well as the number of patients presenting to HIV clinicians for ART and subsequent referrals to ophthalmology, with a subsequent increase in the diagnosis of CMVR. The gene discussed is CD4; the disease is pneumocystosis.