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

Abstract

Background: Replication of cytomegalovirus (CMV) in the absence of an effective immune response is central to the pathogenesis and complications of CMV disease. The interplay of biological, social, economic, and demographic factors have been variously described to provide fertile ground for CMV in HIV infection. Objectives: This study was to determine the predictors of CMV in the setting of HIV infection at two major treatment centres in Makurdi, North Central Nigeria. Materials and Methods: Semi-structured, pre-tested questionnaires were used to obtain relevant socio-demographic information from 268 confirmed HIV patients. Blood samples collected were analyzed with enzyme-linked immunosorbent assay (ELISA) for CMV IgG and IgM. Data were analyzed using Statistical Package for Social Sciences (SPSS). Bivariate and multivariate logistic regression analyses were used to determine the predictors of CMV 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 in HIV. Results: Of the total of 268, 199 were males while 69 were females. Their mean age + SD, was 38.8 + 11.9 years.  Age group (χ2=13.363, df=3, P=0.004) and Type of apartment (χ2=9.581, df=3, P=0.022), all showed significant association with CMV IgG  Age group (χ2 =10.438, df=3, P=0.015), Marital Status (χ2=8.823, df=3, P=0.032) and blood transfusion (χ2=10.091, df=1, P=0.001) 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; [Two bedrooms flat: (aOR=0.223, 95% CI=0.052-0.965, P=0.045)] and Blood transfusion [No blood transfusion: (aOR=0.317, 95% CI=0.165-0.609, P=0.001)]. Conclusion: The strongest predictors of CMV in HIV  were the type of living apartment and blood transfusion. We recommend improved living conditions and blood transfusion practice for these patients in addition to the current interventions to minimize CMV transmission and its complications in HIV patients.