Serum Concentration of Anti-Cytomegalovirus IgG and Ischaemic Stroke in Patients with Advanced HIV Infection in Malawi

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2018 Nov 28

PMID 30481210

Citations 4

Authors

Joseph Kamtchum-Tatuene

Zaid Al-Bayati

Henry Charles Mwandumba

Tom Solomon

Stephen E Christmas

Laura A Benjamin

Affiliations

Soon will be listed here.

Abstract

Background: Studies in high-income settings have shown association between Cytomegalovirus (CMV) infection and adverse cardiovascular outcome, especially in HIV infection. We aimed to study the association between serum concentration of anti-CMV IgG and ischaemic stroke in HIV-infected Malawians.

Methods: Our sample was derived from a case-control stroke study in Malawi. Serum concentration of anti-CMV IgG was measured using enzyme-linked immunosorbent assay. Multivariable logistic regression was used to study the association between high concentrations of anti-CMV IgG (above the third tertile) and ischaemic stroke while adjusting for cardiovascular risk factors.

Results: Overall, 139 HIV-positive adults (48.2% women; 48 ischaemic stroke cases and 91 controls; median age: 45 years) were included. The median CD4+ count was 136 and 401 cell/mm3 (IQR: [75-278] and [230-533]) in cases and controls, respectively. High concentration of anti-CMV IgG was associated with ischaemic stroke in the univariable model (OR = 2.56 [1.23-5.34]) but not after adjusting for duration of antiretroviral therapy (ART), CD4+ count, and other cardiovascular risk factors (OR = 0.94 [0.29-3.08]). Low CD4+ count was an independent predictor of stroke. There was a negative correlation between serum concentration of anti-CMV IgG and CD4+ count (rho = -0.30, p < 0.001).

Conclusions: High concentration of anti-CMV IgG is not independently associated with ischaemic stroke in HIV-infected Malawians. Larger cohort studies are needed to further investigate the role of humoral response to CMV in the pathophysiology of HIV-associated stroke.

Citing Articles

The State of Stroke Research in Malawi: Results from a Mapping Review Study.

Mtambo M, Masangwi D, Soko A, Kaledzera T, Bickton F, Chipeta M J Multidiscip Healthc. 2024; 17:4023-4041.

PMID: 39175495 PMC: 11339346. DOI: 10.2147/JMDH.S476012.

Trends and Clinical Characteristics of HIV and Cerebrovascular Disease in Low- and Middle-Income Countries (LMICs) Between 1990 and 2021.

Ransley G, Zimba S, Gadama Y, Saylor D, Benjamin L Curr HIV/AIDS Rep. 2022; 19(6):548-565.

PMID: 36264482 PMC: 9759508. DOI: 10.1007/s11904-022-00627-9.

Emerging Viral Infections, Hypertension, and Cardiovascular Disease in Sub-Saharan Africa: A Narrative Review.

Yan L, Matuja S, Pain K, McNairy M, Etyang A, Peck R Hypertension. 2022; 79(5):898-905.

PMID: 35272495 PMC: 9010372. DOI: 10.1161/HYPERTENSIONAHA.121.17949.

Endothelial dysfunction and carotid atherosclerosis in Malawian adults: A cross-sectional study.

Kamtchum-Tatuene J, Mwangalika Kachingwe G, Mwandumba H, Solomon T, Benjamin L eNeurologicalSci. 2020; 20:100252.

PMID: 32642566 PMC: 7334363. DOI: 10.1016/j.ensci.2020.100252.

References

Emery V . Restimulating interest in cytomegalovirus as a cofactor for HIV infection. J Infect Dis. 2014; 211(2):169-71. PMC: 4279779. DOI: 10.1093/infdis/jiu419. View

Wilson E, Sereti I . Immune restoration after antiretroviral therapy: the pitfalls of hasty or incomplete repairs. Immunol Rev. 2013; 254(1):343-54. PMC: 3694599. DOI: 10.1111/imr.12064. View

Gianella S, Letendre S . Cytomegalovirus and HIV: A Dangerous Pas de Deux. J Infect Dis. 2016; 214 Suppl 2:S67-74. PMC: 5021239. DOI: 10.1093/infdis/jiw217. View

Preiksaitis J, Hayden R, Tong Y, Pang X, Fryer J, Heath A . Are We There Yet? Impact of the First International Standard for Cytomegalovirus DNA on the Harmonization of Results Reported on Plasma Samples. Clin Infect Dis. 2016; 63(5):583-9. DOI: 10.1093/cid/ciw370. View

Benjamin L, Bryer A, Emsley H, Khoo S, Solomon T, Connor M . HIV infection and stroke: current perspectives and future directions. Lancet Neurol. 2012; 11(10):878-90. PMC: 3460367. DOI: 10.1016/S1474-4422(12)70205-3. View

Lundgren J, Babiker A, Gordin F, Emery S, Grund B, Sharma S . Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. N Engl J Med. 2015; 373(9):795-807. PMC: 4569751. DOI: 10.1056/NEJMoa1506816. View

Adland E, Klenerman P, Goulder P, Matthews P . Ongoing burden of disease and mortality from HIV/CMV coinfection in Africa in the antiretroviral therapy era. Front Microbiol. 2015; 6:1016. PMC: 4585099. DOI: 10.3389/fmicb.2015.01016. View

Hunt P, Martin J, Sinclair E, Epling L, Teague J, Jacobson M . Valganciclovir reduces T cell activation in HIV-infected individuals with incomplete CD4+ T cell recovery on antiretroviral therapy. J Infect Dis. 2011; 203(10):1474-83. PMC: 3080892. DOI: 10.1093/infdis/jir060. View

Parrinello C, Sinclair E, Landay A, Lurain N, Sharrett A, Gange S . Cytomegalovirus immunoglobulin G antibody is associated with subclinical carotid artery disease among HIV-infected women. J Infect Dis. 2012; 205(12):1788-96. PMC: 3415890. DOI: 10.1093/infdis/jis276. View

10.

Gomez-Mora E, Massanella M, Garcia E, Giles D, Bernado M, Urrea V . Elevated humoral response to cytomegalovirus in HIV-infected individuals with poor CD4+ T-cell immune recovery. PLoS One. 2017; 12(9):e0184433. PMC: 5608209. DOI: 10.1371/journal.pone.0184433. View

11.

Benjamin L, Allain T, Mzinganjira H, Connor M, Smith C, Lucas S . The Role of Human Immunodeficiency Virus-Associated Vasculopathy in the Etiology of Stroke. J Infect Dis. 2017; 216(5):545-553. PMC: 5853476. DOI: 10.1093/infdis/jix340. View

12.

Benjamin L, Bryer A, Lucas S, Stanley A, Allain T, Joekes E . Arterial ischemic stroke in HIV: Defining and classifying etiology for research studies. Neurol Neuroimmunol Neuroinflamm. 2016; 3(4):e254. PMC: 4929887. DOI: 10.1212/NXI.0000000000000254. View

13.

Roberts E, Haan M, Dowd J, Aiello A . Cytomegalovirus antibody levels, inflammation, and mortality among elderly Latinos over 9 years of follow-up. Am J Epidemiol. 2010; 172(4):363-71. PMC: 2950794. DOI: 10.1093/aje/kwq177. View

14.

Nikitskaya E, Lebedeva A, Ivanova O, Maryukhnich E, Shpektor A, Grivel J . Cytomegalovirus-Productive Infection Is Associated With Acute Coronary Syndrome. J Am Heart Assoc. 2016; 5(8). PMC: 5015295. DOI: 10.1161/JAHA.116.003759. View

15.

Benjamin L, Corbett E, Connor M, Mzinganjira H, Kampondeni S, Choko A . HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults: A case-control study. Neurology. 2015; 86(4):324-33. PMC: 4776088. DOI: 10.1212/WNL.0000000000002278. View

16.

Cowan L, Alonso A, Pankow J, Folsom A, Rosamond W, Gottesman R . Hospitalized Infection as a Trigger for Acute Ischemic Stroke: The Atherosclerosis Risk in Communities Study. Stroke. 2016; 47(6):1612-7. PMC: 4879064. DOI: 10.1161/STROKEAHA.116.012890. View

17.

Gianella S, Morris S, Tatro E, Vargas M, Haubrich R, Daar E . Virologic correlates of anti-CMV IgG levels in HIV-1-infected men. J Infect Dis. 2013; 209(3):452-6. PMC: 3883163. DOI: 10.1093/infdis/jit434. View

18.

Hunt P, Lee S, Siedner M . Immunologic Biomarkers, Morbidity, and Mortality in Treated HIV Infection. J Infect Dis. 2016; 214 Suppl 2:S44-50. PMC: 5021241. DOI: 10.1093/infdis/jiw275. View

19.

Sico J, Chang C, So-Armah K, Justice A, Hylek E, Skanderson M . HIV status and the risk of ischemic stroke among men. Neurology. 2015; 84(19):1933-40. PMC: 4433456. DOI: 10.1212/WNL.0000000000001560. View

20.

Bates M, Brantsaeter A . Human cytomegalovirus (CMV) in Africa: a neglected but important pathogen. J Virus Erad. 2016; 2(3):136-42. PMC: 4967964. View