Association between cytomegalovirus infection and tuberculosis disease: A systematic review and meta-analysis of epidemiological studies

J Infect Dis. 2022 May 4;jiac179. doi: 10.1093/infdis/jiac179. Online ahead of print.


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.

Keywords: Association; Cytomegalovirus; Latent infection; Mycobacterium; Tuberculosis.