Sero-Prevalence of Human Cytomegalovirus Infection and the Associated Factors among HIV Infected Patients Attending the Comprehensive Care clinic at the Kenyatta National Hospital, Kenya

Abstract

Human Cytomegalovirus (hCMV) is a member of Herpes Virus family. During an active infection in HIV infected patients, it is one of the most common causes of pneumonia, retinitis, gastrointestinal disease, and hepatitis. It is a cofactor in HIV disease. The virus is an opportunistic pathogen in immunocompromised individuals. It is associated with HIV disease progression leading to high mortality and morbidity. The magnitude of hCMV in Kenyan HIV patients is not known, especially at the Kenyatta National Hospital. This problem has not been adequately investigated in Kenya and warrants strong preventive measures. Currently there is scanty data on this disease in Kenya leading to lack of its recognition in HIV patients. To determine the seroprevalence of hCMV infection and its predisposing factors among comprehensive care clinic (CCC) attendees at Kenyatta National Hospital, Nairobi County, Kenya, a cross-sectional study was carried out. Ethical approval was obtained from Kenyatta national hospital and university of Nairobi ethics and research review committee.A systematic random sampling method was used to select participants among the target population. Five millilitres of blood was aseptically collected from each participant by venepuncture. The blood was separated and plasma used to test for presence of hCMV IgM and IgG using enzyme linked immunosorbent assay (ELISA). Demographic data was collected using a questionnaire and data analysed using statistical package for statistical parameter test (SPSS). Bivariate analysis was carried out using chi-square and student t-test. Four hundred HIV-infected participants were recruited. Their mean age (SD) was 42.73 (9.5) years. Of these, 246(61.5%) were females and 154(38.5%) were males. Of 400, 398 (99.0%) were hCMV IgG seropositive, 32 (8.0%) were hCMV IgM seropositive. Age group between 19 and 28 years [OR = 4.8 (1.4-16.4) 95% CI; p=0.012], never been married [OR = 4.3 (1.3-14.5) 95% CI; p=0.020], never had children [OR=3.2 (1.2-8.5) 95% CI; p=0.022] and use of highly active antiretroviral therapy (HAART) [OR=3.5 (1.2-10.3) 95% CI; p=0.031] were significantly associated with hCMV sero positivity using bivariate analysis. In multivariate analysis, both CD4 (p <0.001) and HIV viral loads (p <0.001) were significantly associated with hCMV sero positivity. Routine screening for hCMV in HIV patients would be recommended with emphasis on patients with high viral loads and low CD4 counts.