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

Kok Pim Kua, Bunchai Chongmelaxme, Shaun Wen Huey Lee

Research output: Contribution to journalReview ArticleResearchpeer-review

1 Citation (Scopus)


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 31 December 2021. Data were pooled using random-effects meta-analysis. RESULTS: Of 5476 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 (odds ratio [OR], 3.20; 95% confidence interval [CI], 2.18-4.70). 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 hazard ratio, 2.92; 95% CI, 1.34-4.51; adjusted OR, 1.14; 95% CI, .71-1.57). 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.

Original languageEnglish
Pages (from-to)471-482
Number of pages12
JournalThe Journal of Infectious Diseases
Issue number4
Publication statusPublished - 15 Feb 2023


  • association
  • cytomegalovirus
  • latent infection
  • mycobacterium
  • tuberculosis

Cite this