Association Between Diabetes Mellitus and the Risk of Herpes Zoster: A Systematic Review and Meta-analysis

Huang, Chun-Ta; Lee, Chi-Yu; Sung, Heng-You; Liu, Shu-Jung; Liang, Po-Chih; Tsai, Ming-Chieh

doi:10.1210/clinem/dgab675

Cited by 24 publications

(16 citation statements)

References 44 publications

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“…Common risk factors for HZ are age > 50 years, immunosuppression, infections, and mental stress [14]. A meta-analysis of 16 studies till January 2021 confirmed that patients with diabetes mellitus also have a higher risk (pooled relative risk: 1.38; 95% confidence interval (CI): 1.21-1.57) [15].…”

Section: Epidemiologymentioning

confidence: 99%

Herpes zoster: A Review of Clinical Manifestations and Management

Patil

Goldust

Wollina

2022

Viruses

219

123

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The Varicella-zoster virus (VZV) or human herpes virus 3 is a neurotropic human alpha herpes virus responsible for chickenpox/varicella and shingles/herpes zoster (HZ). This review will focus on HZ. Since HZ is secondary to varicella, its incidence increases with age. In children and youngsters, HZ is rare and associated to metabolic and neoplastic disorders. In adults, advanced age, distress, other infections (such as AIDS or COVID-19), and immunosuppression are the most common risk factors. HZ reactivation has recently been observed after COVID-19 vaccination. The disease shows different clinical stages of variable clinical manifestations. Some of the manifestations bear a higher risk of complications. Among the possible complications, postherpetic neuralgia, a chronic pain disease, is one of the most frequent. HZ vasculitis is associated with morbidity and mortality. Renal and gastrointestinal complications have been reported. The cornerstone of treatment is early intervention with acyclovir or brivudine. Second-line treatments are available. Pain management is essential. For (secondary) prophylaxis, currently two HZV vaccines are available for healthy older adults, a live attenuated VZV vaccine and a recombinant adjuvanted VZV glycoprotein E subunit vaccine. The latter allows vaccination also in severely immunosuppressed patients. This review focuses on manifestations of HZ and its management. Although several articles have been published on HZ, the literature continues to evolve, especially in regard to patients with comorbidities and immunocompromised patients. VZV reactivation has also emerged as an important point of discussion during the COVID-19 pandemic, especially after vaccination. The objective of this review is to discuss current updates related to clinical presentations, complications, and management of HZ.

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Section: Epidemiologymentioning

confidence: 99%

Herpes zoster: A Review of Clinical Manifestations and Management

Patil

Goldust

Wollina

2022

Viruses

219

123

View full text Add to dashboard Cite

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“…Hung et al analyzed 16 studies and discovered that patients with DM had a higher risk of HZ than did the general population, the relative risk was 1.38. The authors thus suggested that the HZ vaccine be considered for patients with DM [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Non-alcoholic fatty liver disease associated with greater herpes zoster risk than alcoholic fatty liver disease

Yu,

Chen,

Cheng

et al. 2023

Eur J Med Res

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Background Disease-related stress can trigger the occurrence of herpes zoster (HZ). Fatty liver disease (FLD) can have adverse effects on the human body and may induce stress in affected individuals. In this study, we investigated whether FLD is associated with an elevated risk of HZ. Methods For this study, we utilized data from the National Health Insurance Research Database, patients with FLD from 2000 to 2017 were observed (follow-up until 2018). Patients were considered to have FLD if they had at least two outpatient visits or at least one admission record with a diagnostic code of FLD. Patients with FLD were matched 1:1 by age, sex, comorbidities, and index year with control patients. Additionally, the FLD was further categorized into non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD) groups. Multivariable Cox proportional hazards model was used to calculate the incidence rate and adjusted hazard ratio (aHR) of HZ for FLD and AFLD and for various age groups, sex and comorbidities. Cumulative incidence curve for HZ was plotted through the Kaplan–Meier method, and p-value was calculated using the log-rank test. Results After 1:1 propensity-score matching, each cohort comprised 62,418 patients. The FLD cohort was further divided into NAFLD and AFLD groups, which respectively comprised 55,709 and 6709 patients. The FLD cohort had a risk of HZ significantly higher than that of the control cohort (aHR = 1.06; p < 0.001). Additionally, the NAFLD group exhibited a significantly higher risk of HZ than did the AFLD group (aHR = 1.22; p < 0.001). Among patients without any comorbidities, those with FLD had a higher risk of HZ than did those without FLD (aHR = 1.14; p < 0.001). Conclusion Patients with FLD are at an increased risk of HZ development. Additionally, NAFLD is associated with a higher risk of HZ than AFLD. Therefore, patients with NAFLD should be informed of their increased risk of HZ.

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“…Since our search of the database identified no relevant studies that included immunocompromised patients, though, further research is needed to assess the efficacy of these agents in such population. For example, another recent meta-analysis found that individuals with diabetes mellitus (DM) were at greater risk of HZ than general population (pooled relative risk [RR]: 1.38; 95% CI, 1.21–1.57) as well as a dose-response association between age and the risk of HZ within the DM population [ 91 ]. Similar results have also been reported in the adult population for individuals with diabetes, who experienced a higher adjusted risk of HZ (hazard ratio = 1.45; 95% CI: 1.43 to 1.46) and higher adjusted odds of persistent post-zoster pain (OR = 1.18, 95% CI: 1.13 to 1.24) [ 92 ].…”

Section: Discussionmentioning

confidence: 99%

Comparing Prodrugs with Acyclovir for Treating Postherpetic Neuralgia among Herpes Zoster Patients: A Systematic Review and Meta-Analysis

Yeh

Chang²,

Huang

et al. 2022

Healthcare

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Postherpetic neuralgia (PHN) is a common, painful, and long-term complication of herpes zoster (HZ). PHN increases the demand for healthcare services and, previous studies showed that patients who received antiviral agents were less likely to develop PHN. The objective of this study was to compare the efficacy of prodrugs and acyclovir in treating PHN among patients with HZ. The search included the PubMed, Medline, Embase, and Cochrane Center of Register of Controlled Trails databases through February 2022. Clinical trials and randomized controlled trials (RCTs) involving antiviral agent intervention for HZ patients diagnosed with PHN were eligible for inclusion. A meta-analysis was conducted to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs) with a fix-effect model. Five RCTs with 1147 HZ patients met our eligibility criteria. Our meta-analysis found that there was a significantly lower risk of PHN for members of the prodrugs group (famciclovir and valaciclovir) compared with those who received acyclovir (RR = 0.86, 95%, CI: 0.75 to 0.98, p = 0.03). The review of studies indicated that the efficacy of prodrugs was better than acyclovir for reliving PHN.

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Association Between Diabetes Mellitus and the Risk of Herpes Zoster: A Systematic Review and Meta-analysis

Cited by 24 publications

References 44 publications

Herpes zoster: A Review of Clinical Manifestations and Management

Herpes zoster: A Review of Clinical Manifestations and Management

Non-alcoholic fatty liver disease associated with greater herpes zoster risk than alcoholic fatty liver disease

Comparing Prodrugs with Acyclovir for Treating Postherpetic Neuralgia among Herpes Zoster Patients: A Systematic Review and Meta-Analysis

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