Prior Cytomegalovirus Associated With Increased Risk for Tuberculosis

Individuals with cytomegalovirus (CMV) infection may be at increased risk for tuberculosis (TB) infection, according to results of a systematic review and meta-analysis published in The Journal of Infectious Diseases.

Investigators searched 6 databases for studies that assessed the epidemiologic association between CMV and TB. Pooled data were used to perform a random-effects meta-analysis.

The 15 studies included in the analysis comprised 38,618 patients. There were 2 prospective cohort studies, 2 retrospective cohort studies, 8 cross-sectional studies, and 3 case-control studies. The cross-sectional studies had a low-to-unclear risk of bias due to a lack of adequate information to assess individual domains.

In the pooled analysis, results showed that the risk for TB infection was increased among patients with CMV infection (odds ratio [OR], 3.20; 95% CI, 2.18-4.70; I² =35%) compared with those without the infection. Further analysis showed that this association between CMV and subsequent TB infection was statistically significant (risk ratio, 2.16; 95% CI, 1.08-4.31; I² =94%).

After adjustment for sex, age, ethnicity, and confirmed HIV infection, the association between CMV and subsequent TB infection remained significant (adjusted hazard ratio, 2.92; 95% CI, 1.34-4.51).

The researchers then assessed data from studies that included CMV antibody measurements. Pooled results showed an increased risk for incident TB infection among patients with significantly increased concentrations of CMV antibodies (OR, 4.07; 99% CI, -0.70 to 8.84).

This analysis was limited by potential bias as several studies had a small sample size.

“The strong association between [CMV] infection and progression to active [TB]…suggests the importance of prioritizing latent [TB] screening for individuals with documented [CMV] positivity,” the researched concluded.

Reference

Kua KP, Chongmelaxme B, Lee S. Association between cytomegalovirus infection and tuberculosis disease: A systematic review and meta-analysis of epidemiological studies. J Infect Dis. Published online May 4, 2022. doi:10.1093/infdis/jiac179