Highlights
- •There is evidence of the regional differences in the association between CMV IgG and MS.
- •In Europe, CMV seroprevalence in MS patients is less than controls.
- •In the middle east region, CMV IgG seropositivity is more prevalent in MS than controls.
- •No statistically significant association of CMV IgG and MS in north america.
- •Further studies are needed to identify the potential effect modifiers of this association.
Abstract
Background
Despite of a few decades of investigations, the association and role of cytomegalovirus
(CMV) and multiple sclerosis (MS) remain inconclusive. Herein, we performed a meta-analysis
to investigate the association between CMV IgG serostatus and MS.
Methods
A literature search was conducted on MEDLINE, EMBASE, and Cochrane databases. Eligibility
criteria included observational studies assessing the seroprevalence of CMV immunoglobulin
G (IgG) in adults with MS and non-MS control. Two authors screened all resulting studies
and evaluated the quality of the included studies. Pooled odd ratios (ORs) and 95%
confidence intervals (CIs) were estimated using a random-effect model.
Results
The search identified 771 unique citations, and 15 (3,591 MS patients and 4,241 controls)
satisfied eligibility criteria. The meta-analysis of all included studies showed no
significant association between CMV IgG seropositivity and MS with a substantial heterogeneity
(OR 1.190; 95%CI 0.780–1.813; I2 32.7%). Subgroup analysis, stratified by geographic area, showed different associations
and less heterogeneity in each geographical area. In Europe, CMV IgG seroprevalence
was lower among people with MS than controls (OR 0.750; 95%CI 0.599–0.940; I213.9%). In contrast, CMV IgG seropositivity was more common among MS patients compared
to controls in the Middle East region (OR 5.089; 95%CI 01.067–24.263; I2 5.6%). There was no significant association in North America.
Conclusions
There is evidence of the regional differences in the association between CMV IgG seropositivity
and MS. Further biological and epidemiological studies are needed to identify the
genetic or environmental factors which are potentially the effect modifiers of this
association.
Keywords
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Article info
Publication history
Published online: July 11, 2020
Accepted:
July 11,
2020
Received in revised form:
July 8,
2020
Received:
June 9,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
