Association Between Latent Cytomegalovirus and Severe COVID-19 Infection

Latent cytomegalovirus (CMV) infection was found to be associated with a significantly increased risk for progression to severe disease and subsequent hospitalization among patients with COVID-19 infection, regardless of demographic factors. These findings were published in The Journal of Infectious Diseases.

In this retrospective cohort study, researchers sought to determine the association between latent CMV infection and the risk for severe COVID-19 infection. They assessed serum samples from 984 patients that were obtained prior to the COVID-19 pandemic for evidence seropositive CMV infection. Of these patients, 617 (62.7%) were seropositive for CMV infection. All patients were subsequently assessed for SARS-CoV-2 infection via reverse transcription polymerase chain reaction (RT-PCR) testing. Among all patients included in the study, results of RT-PCR testing showed that 246 were positive and 738 were negative for SARS-CoV-2 infection. To control for demographic characteristics, patients who tested positive for SARS-CoV-2 infection were matched in a 1:3 fashion against those who tested negative for the infection on the basis of sex, age, and self-reported race/ethnicity.

Among all patients included in the study, the median age was 54 (SD, ± 16) years, 60% were White, 23% were Black, and 41% were men.

The researchers found that the prevalence of RT-PCR-confirmed SARS-CoV-2 infection was increased among patients who were seropositive vs those who were seronegative for CMV infection (28.5% vs 19%). Binomial logistic regression analysis showed that CMV seropositivity was associated with a significantly increased risk for severe SARS-CoV-2 infection (odds ratio [OR], 1.7; 95% CI, 1.25-2.33; P =.001).

To further assess the effect of CMV seropositivity on outcomes of COVID-19 infection, the researchers categorized patients into 4 groups. The 4 groups comprised 738 patients (group 0) who were negative for SARS-CoV-2 infection; 167 (group 1) who were positive for the infection; 49 (group 2) who were hospitalized for the infection but did not require transfer to an intensive care unit (ICU); and 30 (group 3) with the infection who required transfer to an ICU. Of patients in groups 0, 1, 2, and 3, 59.7%, 65.8%, 87.8%, and 76.7% were seropositive for CMV infection, respectively, indicating an association between CMV seropositivity and an increased risk for severe SARS-CoV-2 infection (P =.0003 for groups 0-3 and P =.01 for groups 1-3).

Additional analysis was performed to determine the effect of CMV seropositivity on the risk for hospitalization due to severe SARS-CoV-2 infection. Results showed that among patients with SARS-CoV-2 infection, the rate of hospitalization was increased in those who were seropositive vs those who were seronegative for CMV infection (37.5% vs 18.5%). An increased risk for hospitalization due to COVID-19 among patients who were seropositive for CMV infection was found to be associated with self-reported race/ethnicity and sex (OR, 2.63; 95% CI, 1.37-5.35; P =.005), as well as age (OR, 1.06- 95% CI, 1.04-1.09; P <.001).

This study was limited by the inability to exclude patients with seronegative CMV infection who may have subsequently become seropositive over time due to its retrospective design.

According to the researchers, “these [findings] support the possible use of CMV seropositivity as part of a risk stratification approach for [patients with] COVID-19 [infection].”

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 

Reference

Alanio C, Verma A, Mathew D, et al. Cytomegalovirus latent infection is associated with an increased risk of COVID-19-related hospitalization. J Infect Dis. Published February 2, 2022. doi:10.1093/infdis/jiac020