Association Between Cytomegalovirus Infection and Tuberculosis Disease: A Systematic Review and Meta-Analysis of Epidemiological Studies

Abstract

Background Tuberculosis is one of the leading causes of mortality worldwide from an infectious disease. This review aimed to investigate the association between prior cytomegalovirus infection and tuberculosis disease. Methods Six bibliographic databases were searched from their respective inception to December 31, 2021. Data were pooled using random-effects meta-analysis. Results Of 5,476 identified articles, 15 satisfied the inclusion criteria with a total sample size of 38,618 patients. Pooled findings showed that individuals with cytomegalovirus infection had a higher risk of tuberculosis disease compared to those not infected with cytomegalovirus (OR: 3.20, 95% CI: 2.18 to 4.70). Age was the only covariate that exerted a significant effect on the result of the association. Meta-analysis of risk estimates reported in individual studies showed a marked and significant correlation of cytomegalovirus infection with active tuberculosis (Adjusted HR: 2.92, 95% CI: 1.34 to 4.51; Adjusted OR: 1.14, 95% CI: 0.71 to 1.57). A clear dose-response relation was inferred between the levels of cytomegalovirus antibodies and the risks of tuberculosis events (OR for high levels of cytomegalovirus antibodies: 4.07; OR for medium levels of cytomegalovirus antibodies: 3.58). Conclusions The results suggest an elevated risk of tuberculosis disease among individuals with a prior cytomegalovirus infection.

Human Cytomegalovirus Immunoglobulin G Response and Pulmonary Tuberculosis in Adolescents: A Case-Control Study

“…A systematic review and meta-analysis of epidemiological studies have provided further evidence for an association between HCMV infection and risk of tuberculosis disease [ 12 ]. However, much remains unknown about the mechanisms that are responsible for the increased susceptibility to tuberculosis.…”