Cytomegalovirus infection and its association with systemic lupus erythematosus: Systematic review and meta-analysis

Background Systemic lupus erythematosus (SLE) is an autoimmune disorder marked by inflammation and immune dysregulation. Environmental factors like viral infections may contribute to disease onset. Cytomegalovirus (CMV), a beta-herpesvirus capable of immune evasion, has been proposed as a trigger in SLE pathogenesis, though studies show conflicting results. Materials and Methods A literature search of PubMed, Scopus, Embase, Web of Science, and ScienceDirect identified eligible reports examining CMV prevalence and SLE association. Studies were selected using predefined criteria. Data were analyzed using Comprehensive Meta-Analysis (CMA) v4 software. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Heterogeneity and publication bias were evaluated using Tau square, Cochrane’s Q, I 2 statistics, funnel plots, and Egger’s regression test. Sensitivity analyses determined robustness. Results Twelve case-control studies comprising 1267 SLE patients and 1417 healthy controls were included. In the healthy control group, antibodies against CMV, specifically IgG (0.728) and IgA (0.641), were more prevalent than CMV DNA (0.095) and IgM (0.051). CMV DNA (OR: 9.727, 95% CI = 1.136 to 83.260, p = .038) and CMV IgM (OR: 2.630, 95% CI: 1.665 to 4.155, p = .000) were significantly more prevalent in SLE patients than in controls, suggesting a possible role for active or recent CMV infection in SLE development. Sensitivity analyses demonstrated overall consistency of findings; however, the association for CMV DNA showed variability across studies and should be interpreted with caution. Conclusion This meta-analysis shows a link between CMV infection and SLE, suggesting CMV may be an environmental risk factor in SLE pathogenesis. Further research is needed to understand mechanisms and evaluate antiviral strategies.