Important Predictors of Cytomegalovirus Infection in the Setting of Human Immunodeficiency Virus Infection, in Makurdi, North Central Nigeria

Abstract

<p><strong>ABSTRACT</strong></p><p><strong>Background</strong>: Replication of cytomegalovirus (CMV) in the absence of an effective immune response is central to the pathogenesis of CMV disease. Therefore, complications of CMV are primarily seen in individuals whose immune system are immature, or are suppressed by drug treatment or co-infection with pathogens like the human immunodeficiency virus (HIV). The interplay of biological, social, economic and demographic factors have been variously described to provide fertile ground for CMV infection and its complications in the setting of HIV infection. <strong>Objectives</strong>: This study aimed to determine the predictors of CMV in the setting of HIV infection at two major treatment centres in Makurdi, North Central Nigeria. <strong>Materials and Methods</strong>: A total of 268 patients with confirmed HIV infection were recruited from two large HIV treatment centers in Makurdi, Benue State, Nigeria. Semi-structured, pre-tested questionnaires were used to obtain relevant socio-demographic information. Blood samples were also collected, the serum separated, stored at -20 oC and later analyzed with enzyme-linked immunosorbent assay (ELISA) for CMV IgG/IgM. The data were analyzed using Statistical Package for Social Sciences (SPSS). Chi-square test was used to test the association between variables and CMV IgG/IgM. Bivariate and multivariate logistic regression analyses were used to determine the predictors of CMV infection by estimating odds ratios and their 95% confidence intervals (CI) at a significance level of p < 0.05. Only variables which showed significant association in the bivariate analysis were included in the multivariate analysis, to obtain the most significant predictors of CMV infection in HIV. <strong>Results</strong>: Of the total of 268 patients assessed, 199 were males while 69 were females. Their mean age + SD, was 38.8 + 11.9 years.  Age group (<i>χ2=13.363, df=3, P=0.004</i>) and Type of apartment (<i>χ2=9.581, df=3, P=0.022</i>), all showed significant association with CMV IgG  Age group (<i>χ2 =10.438, df=3, P=0.015</i>), Marital Status (<i>χ2=8.823, df=3, P=0.032</i>) and blood transfusion (<i>χ2=10.091, df=1, P=0.001</i>) all showed significant association with CMV IgM. Multivariate analysis revealed the strongest predictors of CMV in the setting of HIV infection to be Type of apartment; [<i>Two bedrooms flat (aOR=0.223, 95% CI=0.052-0.965, P=0.045</i>)] and Blood transfusion [No blood transfusion (<i>aOR=0.317, 95% CI=0.165-0.609, P=0.001</i>)]. <strong>Conclusion</strong>: The strongest predictors of CMV infection in the setting of HIV in our environment were the type of living apartment and blood transfusion. We recommend improved living condition and blood transfusion practice for this category of patients in addition to the current interventions to minimize CMV transmission and its complications in HIV patients.</p&gt