Incidence and Risk of Postherpetic Neuralgia after Varicella Zoster Virus Infection in Hematopoietic Cell Transplantation Recipients: Hokkaido Hematology Study Group

Abstract

To assess the incidence of and risk factors associated with postherpetic neuralgia (PHN) after hematopoietic cell transplantation (HCT) varicella zoster virus (VZV) infection, we conducted a retrospective chart review of 418 consecutive patients who underwent HCT between April 2005 and March 2007. The male/female ratio was 221/197, median age at HCT was 47 years (range: 0-69 years), and autologous/allogeneic/syngeneic HCT ratio was 154/263/1. Seventy-eight patients developed VZV infection after HCT. Sixty-two patients had localized zoster, 11 patients had disseminated zoster (rash like chicken pox), and 4 patients had visceral zoster. All cases were treated with acyclovir (ACV) or valacyclovir (VACV), and there was no VZV infection-related death. Twenty-seven (35%) of the 78 patients with VZV infection suffered PHN after resolution of VZV infection. Multivariate analysis showed that advanced age is the only risk factor in autologous HCT (P = .0075; odds ratio [OR] = 1.14; 95% confidence interval [CI], 0.97-1.33). On the other hand, advanced age (P = .0097; OR = 1.06; 95% CI, 1.01-1.12), male gender (P = .0055; OR = 12.7; 95% CI, 1.61-100.1), and graft-versus-host disease (GVHD) prophylaxis with a tacrolimus-based regimen (P = .0092; OR = 9.56; 95% CI, 1.44-63.3) were associated with increased risk of PHN in allogeneic HCT. This study for the first time clarified the risk of PHN in HCT recipients.

Low-dose acyclovir prophylaxis for the prevention of herpes simplex virus and varicella zoster virus diseases after autologous hematopoietic stem cell transplantation

“…HSV disease sometimes causes severe oral or genital ulceration, esophagitis, and disseminated diseases, although rarely life threatening. On the other hand, VZV disease occurs in approximately 16-28 % without long-term prophylaxis [2][3][4][5] and typically presents as a localized dermatomal rash. In addition, disseminated VZV disease, which can result in a fatal outcome [6], and various complications including postherpetic neuralgia and secondary bacterial infections are sometimes observed and may influence the patient's quality of life [2][3][4][5]7].…”

Persistence of varicella-zoster virus viraemia in patients with herpes zoster

“…For this analysis, as well as all patients, we separately analysed only immunocompetent patients (n = 56) as the natural history of both pain and viral DNA load dynamics are likely to be different from those of immunocompromised patients. 24 The association between antibody titres and viral DNA loads was assessed with Pearson's correlation coefficient with associated p-values for a test of zero correlation. Depending on the analysis, Minitab version 15, SAS 9.2 or SPSS version 16.0 were used.…”

Live (vaccines) from New York

“…25,28 VZV can be further complicated by superinfection and post-herpetic neuralgia in as many as 35% of patients following reactivation. 26 As primary varicella occurring after 10 years of age is associated with increased morbidity 27 and the incidence of shingles following HCT is increased compared with the general population, 25,28 efforts to reduce these infections post HCT is clearly warranted.…”

“…Reactivation typically occurs within 2 years of HCT with a reported incidence of 18-48%. [25][26][27] Reactivation can result in localized cutaneous zoster, disseminated cutaneous or visceral zoster, and can even be fatal. 25,28 VZV can be further complicated by superinfection and post-herpetic neuralgia in as many as 35% of patients following reactivation.…”