High incidence of herpes zoster in patients with systemic lupus erythematosus: an immunological analysis.

Abstract

The incidence of herpes zoster was determined in patients with systemic lupus erythematosus (SLE) and the cellular and humoral immunity to varicella zoster virus (VZV) investigated in 45 of these 92 patients.The incidence of herpes zoster was high, occurring in 40 patients (43%) Patients and methods PATIENTS WITH CONTROLSNinety two patients (89 women, three men) who fulfilled the criteria of the American Rheumatism Association for SLE20 were enrolled in this study. They had a mean age of 36-8 (range 19-68) years. The history of herpes zoster was obtained at interview with the patients and was confirmed by doctors' records.Cellular and humoral immunity to VZV was evaluated in 45 of these 92 patients (44 women and one man with a mean age of 37-2 (range 22-68) years) and in 15 healthy subjects with no history of zoster (11 women and four men with a mean age of 35-0 (23-52) years). Patients with a history of herpes zoster within the last six months were excluded from the immunological study. At the time of the immunological study 36 patients were receiving corticosteroids alone(1-25-30 mg/day of prednisolone) and nine were receiving corticosteroids and immunosuppressants (50 mg/day of cyclophosphamide or azathioprine).

No evidence of family history as a risk factor for herpes zoster in patients with post‐herpetic neuralgia

“…Reactivation of latent varicella zoster virus as herpes zoster is thought to result from waning of specific cell-mediated immunity, but little is known about its determinants in individuals with no underlying immunosuppression [Morenz et al, 1980;Nagasawa et al, 1990;Alliegro et al, 1996;Thomas and Hall, 2004]. A recent study investigated genetic susceptibility to zoster, analyzing polymorphisms at the promoter region of the gene for interleukin 10, a cytokine known to downregulate cell-mediated immunity [Haanpaa et al, 2002], and showed that a significantly higher proportion (53%) of 60 immunocompetent patients with herpes zoster carried the ATA haplotype at this region of the gene compared with 152 (38%) of 400 blood donors.…”

The Epidemiology and Prevention of Herpes Zoster

“…The PPV will vary depending on HIV prevalence in the population; reported PPVs of zoster for HIV vary from 3.7% in Brazil to 91% in a Ugandan study population [41,42]. The risk of zoster is also markedly increased among those with leukemia, lymphoma, and metastatic malignancies and among those with selected autoimmune disorders, although disentangling immunosuppression related to disease pathology from immunosuppressive therapies for these conditions (discussed below) is challenging [15,26,[43][44][45][46][47]. Recent studies have indicated that diseases associated with less marked immune suppression may also increase the risk of zoster.…”

Pain in systemic connective tissue diseases

“…Immunological studies of SLE patients have shown abnormal T cell-mediated cytotoxicity, and the suppression of cellular immunity may be involved in the pathogenesis of virus reactivation [31]. It is known that disease activity and the use of corticosteroids and/or immunosuppressive therapies contribute to HZ infection, although a study of a large cohort of SLE patients showed an annual HZ incidence rate of 6.4 events/1000 patientyears without any association with disease activity (SLEDAI <8); post-herpetic neuralgia was detected in 19% of the patients [32].…”