Risk of systemic lupus erythematosus in patients with human papillomavirus infection: a population-based retrospective cohort study

Lh, Shi; Jy, Huang; Yz, Liu; Chiou, J-Y; Wu, Rui; Wei, James Cheng‐Chung

doi:10.1177/0961203318809179

Cited by 13 publications

(12 citation statements)

References 14 publications

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“…Studies have reported that SLE can increase infection and mortality risks, particularly in patients on a high steroid or immunosuppressant dose, with the respiratory tract being the most commonly involved, followed by the bloodstream, and bacteria being the most common causative agent, followed by viruses and fungi [21][22][23] . Moreover, infection rate is highest in the initial stages after SLE diagnosis, particularly the initial 5 years 22 .…”

Section: Discussionmentioning

confidence: 99%

Deep Neck Infection in Systemic Lupus Erythematosus Patients: Real-World Evidence

Chang

Lin

et al. 2020

Sci Rep

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Systemic lupus erythematosus (SLE) might increase deep neck infection (DNI) risk, but evidencesupporting this hypothesis is limited. In this retrospective follow-up study, the SLE-DNI association was investigated using data from the Registry for Catastrophic Illness Patients, which is a subset of the Taiwan National Health Insurance Research Database. All patients newly diagnosed as having SLE in 1997-2011 were identified, and every SLE patient was individually matched to four patients without SLE according to sex, age, and socioeconomic status. The study outcome was DNI occurrence. DNI treatment modalities and prognoses in SLE and non-SLE patients, along with the association of steroid dose with DNI risk, were also studied. In total, 17,426 SLE and 69,704 non-SLE patients were enrolled. Cumulative DNI incidence was significantly higher in the SLE cohort than in the non-SLE cohort (p < 0.001). The Cox regression model demonstrated that SLE significantly increased DNI risk (hazard ratio: 4.70; 95% confidence interval: 3.50-6.32, p < 0.001). Moreover, in the sensitivity and subgroup analyses, the effect of SLE on DNI was stable. Relatively few SLE-DNI patients received surgical interventions (15.6% vs. 28.6%, p = 0.033). The between-group differences in tracheostomy use and hospitalisation duration were nonsignificant. In SLE patients, high steroid doses significantly increased Dni incidence (≥3 vs. <3 mg/day = 2.21% vs. 0.52%, p < 0.001). This is the first study demonstrating that SLE increases DNI risk by approximately five times and that high steroid dose increases DNI incidence in SLe patients. The prevalent infectious disease deep neck infection (DNI) is typically encountered in emergency departments.Patients with DNI typically require intensive care and aggressive treatment. DNI has the likelihood to be life threatening, notably in systemic disease patients and elderly individuals 1-3 . Immunocompromised patients do not show usual symptoms of DNI, making its early diagnosis difficult, possibly increasing complications and mortality 1,3-5 . Therefore, investigating the influence of immunosuppressing diseases on DNI is important.Systemic lupus erythematosus (SLE) renders its affected patients vulnerable to infection; in addition, in such patients undergoing dialysis, infection is a notable cause of mortality 6-9 . SLE activity itself and long-term usage of immunosuppressants are considered the two main causes for infection susceptibility 6,10 . In their case series of 130 patients with DNI, Yang et al. 11 reported two cases of DNI in patients with SLE under steroid therapy. However, the influence of SLE on DNI was not investigated in depth. In addition, the association between the duration of SLE, steroid dosage, and DNI risk remains unknown. We therefore conducted this real-world study with the primary purpose of probing the influence exerted by SLE on DNI incidence, treatment, and prognosis.

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Section: Discussionmentioning

confidence: 99%

Deep Neck Infection in Systemic Lupus Erythematosus Patients: Real-World Evidence

Chang

Lin

et al. 2020

Sci Rep

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“…The SLE event was defined as diagnosis with ICD-9-CM code 710.0 (at least one hospital admission or three outpatient visits) and using HCQ within one year after diagnosis. 25–28 As a result, the data for the diagnosis of SLE should be accurate and reliable. However, the number of new SLE cases was rather small, despite the large number in both cohorts.…”

Section: Discussionmentioning

confidence: 99%

Effect of early eradication therapy on systemic lupus erythematosus risk in patients with Helicobacter pylori infection: a nationwide population-based cohort study

Huang

Chen

et al. 2020

Lupus

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Background This study aimed to investigate whether early eradication therapy influences systemic lupus erythematosus (SLE) risk in patients with Helicobacter pylori (HP) infection. Methods We identified 41,653 patients with HP infection in Taiwan from 2000 to 2013. The patient population was divided into early (within three months) and late (after three months) eradication cohorts. age, sex, co-morbidities and medical visits were matched at a 1:1 ratio. Multiple Cox regression, sensitivity analysis and stratified analysis were used to estimate SLE adjusted hazard ratios (aHR). Results The relative risk of SLE was 0.75 (95% confidence interval 0.43–1.31) in the early eradication cohort. After multivariate adjustment, the SLE risk was non-significantly lower in the early eradication cohort than in the late eradication cohort (aHR = 0.74, 95% CI 0.42–1.29). Stratified analysis revealed that early eradication could significantly reduce SLE risk during the three-year follow-up period (aHR = 0.16, 95% CI 0.05–0.53, p for interaction = 0.0013). Compared to eradication within three months of diagnosis, eradication within 3–36 months and >36 months corresponded with SLE aHRs of 4.78 (95% CI 1.19–19.20) and 7.66 (95% CI 2.17–27.05), respectively, when the follow-up period was less than three years. Conclusion Early HP eradication could significantly reduce SLE risk, especially in the first three-year follow-up.

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“…Other infections, such as Epstein-Barr virus, cytomegalovirus, and human immunodeficiency virus, have also been reported to be associated with BP (15)(16)(17). Human papillomaviruses (HPV) are small double-stranded DNA viruses known as risk factors for multiple cancers (18)(19)(20) and are also associated with autoimmune diseases, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) (21)(22)(23). The shared pathogenesis between these autoimmune diseases and BP is based on a viral infection and a subsequent autoimmune reaction (24,25).…”

Section: Introductionmentioning

confidence: 99%

The Potential Role of Human Papillomavirus Infection in Bell's Palsy: A Hypothesis-Generating Study Based on a Nationwide Cohort

Chou

Chang

et al. 2021

Front. Med.

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Objective: Our purpose was to investigate whether people with a previous human papillomavirus (HPV) infection were associated with an increased risk of Bell's palsy (BP).Methods: By using Taiwan population-based data, patients aged > 18 years with HPV infection (n = 22,260) from 2000 to 2012 were enrolled and compared with control subjects who had never been diagnosed with an HPV infection at a 1:4 ratio matched by sex, age, index date, and co-morbidities (n = 89,040). The index date was the first date of HPV diagnosis. All the patients were tracked until the occurrence of BP. Cox proportional hazards regression was applied to estimate the hazard ratios (HRs) for the development of BP in both groups.Results: The HPV group had 1.25 [95% confidence interval (CI) = 1.03–1.51] times higher risk of BP compared with the non-HPV group after adjusting for sex, age, and co-morbidities. The association of HPV and BP was significant in the sensitivity analyses. In the subgroup analysis, the impact of HPV infection on the risk of BP was more pronounced in the elderly > 50 years [adjusted hazard ratio (aHR) =1.86; 95% CI = 1.37–2.52], hypertension (aHR = 1.65; 95% CI = 1.17–2.31), and chronic obstructive pulmonary disease (aHR = 2.14, 95% CI 1.333.43) subgroups.Conclusions: Patients with HPV infection have a higher risk of subsequent BP compared with non-HPV patients. More rigorous studies are needed to confirm if and how specific HPV genotypes are associated with BP and the possible role of vaccines in disease prevention.

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Risk of systemic lupus erythematosus in patients with human papillomavirus infection: a population-based retrospective cohort study

Cited by 13 publications

References 14 publications

Deep Neck Infection in Systemic Lupus Erythematosus Patients: Real-World Evidence

Deep Neck Infection in Systemic Lupus Erythematosus Patients: Real-World Evidence

Effect of early eradication therapy on systemic lupus erythematosus risk in patients with Helicobacter pylori infection: a nationwide population-based cohort study

The Potential Role of Human Papillomavirus Infection in Bell's Palsy: A Hypothesis-Generating Study Based on a Nationwide Cohort

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