Risk factors associated with cytomegalovirus reactivation in patients receiving immunosuppressive therapy for rheumatic diseases: a retrospective study

Abstract

Immunosuppressive treatment is a common cause of cytomegalovirus (CMV) reactivation. However, there is no consensus regarding the risk factors for CMV reactivation in rheumatic diseases. Therefore, this study aimed to elucidate the risk factors associated with CMV reactivation. We retrospectively collected the data of 472 patients with rheumatic diseases whose CMV pp65 antigen (C7-HRP) titer was measured. We divided the patients into those with and those without C7-HRP. We retrospectively collected data on age, sex, primary condition and organ involvement, and blood test results. We also investigated the use of immunosuppressants and the maximum and cumulative doses of prednisolone (PSL). We performed univariate and multivariate analyses to identify risk factors for CMV reactivation. Multivariate analysis showed that higher age (71.2 vs. 64.4 years, p = 0.0022), hypoalbuminemia (2.9 vs. 3.4 g/dL, p = 0.0104), higher creatinine level (1.2 vs. 0.9 mg/dL, p = 0.0026), cyclosporine use (8.2 vs. 3.6%, p = 0.0101), and higher maximum (552.4 vs. 243.3 mg, p < 0.0001) and cumulative (2785.9 vs. 1330.5 mg, p < 0.0001) doses of PSL were associated with CMV reactivation. Older age, hypoalbuminemia, higher creatinine level, cyclosporine use, and higher maximum and cumulative doses of PSL were significant risk factors for CMV reactivation in rheumatic diseases.

A case of varicella due to primary varicella zoster virus infection followed by respiratory disease on the background of an immunocompromised condition

“…The hypothesis regarding CMV reactivation in VZV‐infectious diseases may be supported by the following evidence: (i) VZV infection is reported to induce apoptosis of lymphocytes, resulting in decrease of lymphocyte count in the peripheral blood 1,2 ; (ii) decreased lymphocyte count in the peripheral blood is reported to relate to CMV reactivation 9 . Furthermore, Ohtaki et al.…”

“…The hypothesis regarding CMV reactivation in VZVinfectious diseases may be supported by the following evidence: (i) VZV infection is reported to induce apoptosis of lymphocytes, resulting in decrease of lymphocyte count in the peripheral blood 1,2 ; (ii) decreased lymphocyte count in the peripheral blood is reported to relate to CMV reactivation. 9 Furthermore, Ohtaki et al showed that CMV was reactivated after an inoculation with VZV in an experiment on monkeys. 10 If pneumonia was involved with CMV reactivation in the present case, it follows that VZV infection preceded CMV pneumonia in accordance with the previous reports.…”

Epidemiology and risk factors for cytomegalovirus disease in autoimmune inflammatory rheumatic diseases: A nationwide population‐based study in Taiwan

“…For non-SLE AIIRDs, despite several previous reports of CMV infection in these vulnerable patients, along with the possible impact on immunopathogenesis, most current studies have focused on the seroprevalence of CMV antigenemia or antibodies, or otherwise case series and single medical center-based studies of clinically significant CMV diseases. 3,4,8 Herein the present study, we conducted the analyses based on the large-scale nationwide database. Compared to the previous literature that reported the IRs of overall opportunistic infections in AIIRDs, the present study focused on whether different AIIRDs were associated with different risks specific for CMV diseases, which has been rarely investigated.…”

“…Tzu-Hao Li 1,2,3,4 Chin-Fang Su 5,6 Chien-Chih Lai 2,3,7 Yu-Fan Chang 2,3,8 Fang-Yi Wu 9 Yu-Sheng Chang 5,6…”

“…However, the previous research has focused on CMV seropositivity and CMV reactivation rather than clinical CMV diseases, and the absence of relatively largescale epidemiologic evidence of the prevalence and effects of medications remains a critical gap in the literature. 2,3 In this nationwide cohort study, we used Taiwan's National Health Insurance Research Database (NHIRD), which includes more than 23 million residents of Taiwan. We identified patients with newly diagnosed AIIRDs, including rheumatoid arthritis (RA), primary Sjögren's syndrome (pSS), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and dermatomyositis/polymyositis (DM/PM), between 1997 and 2012 using corresponding International Classification of…”