Varicella zoster virus infections increase the risk of disease flares in patients with SLE: a matched cohort study

Abstract

ObjectiveTo explore whether varicella zoster virus (VZV) infection could increase the risk of disease flares in patients with SLE.MethodsPatients who had VZV reactivations between January 2013 and April 2018 were included from the SLE database (n=1901) of Shanghai Ren Ji Hospital, South Campus. Matched patients with SLE were selected as background controls with a 3:1 ratio. Patients with SLE with symptomatic bacterial infections of the lower urinary tract (UTI) were identified as infection controls. Baseline period and index period were defined as 3 months before and after infection event, respectively. Control period was the following 3 months after the index period. Flare was defined by SELENA SLEDAI Flare Index. Kaplan-Meier analysis, Cox regression model and propensity score weighting were applied.ResultsPatients with VZV infections (n=47), UTI controls (n=28) and matched SLE background controls (n=141) were included. 16 flares (34%) in the VZV group within the index period were observed, as opposed to only 7.1% in UTI controls and 9.9% in background controls. Kaplan-Meier curve revealed that patients with a VZV infection had a much lower flare-free survival within the index period compared with the controls (p=0.0003). Furthermore, after adjusting for relevant confounders including baseline disease activity and intensity of immunosuppressive therapy, Cox regression analysis and propensity score weighting confirmed that VZV infection within 3 months was an independent risk factor for SLE flares (HR 3.70 and HR 4.16, respectively).ConclusionsIn patients with SLE, recent VZV infection within 3 months was associated with increased risk of disease flares.

COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease

“…38,39 In patients with SLE, viral infections can also trigger SLE flares after the virus is cleared. 39,40 In comparison, Influenza A infection in lupus-prone Fas lpr mice is cleared effectively and is not associated with worsening autoimmune features in the acute setting, although these mice can subsequently develop severe pulmonary inflammation weeks after viral clearance. 41 Notably, annual vaccination against influenza is associated with decreased hospitalization and ICU admissions in patients with SLE; hence this practice is highly encouraged.…”

Metagenomic analysis of a throat swab sample collected in China on a patient infected with Varicella Zoster Virus

“…A recent report described a disseminated VZV infection likely to have caused the death of a 49-year-old LN patient 29 . A matched cohort study confirmed that adult patients with SLE presented an increased risk of disease flares if they were infected with VZV 30 . Most of the reports of an effect of VZV on SLE/LN patients concerned adult patients with herpes zoster 30 , 31 .…”

“…A matched cohort study confirmed that adult patients with SLE presented an increased risk of disease flares if they were infected with VZV 30 . Most of the reports of an effect of VZV on SLE/LN patients concerned adult patients with herpes zoster 30 , 31 . To our knowledge, any effect of varicella disease on lupus remains to be reported.…”

Metagenomic Analysis of a Throat Swab Sample Collected in China on A Patient Infected With Varicella Zoster Virus

“…A recent report described a disseminated VZV infection likely to have caused the death of an LN patient 28 . A matched cohort study con rmed that patients with SLE presented an increased risk of disease ares if they were infected with VZV 29 . To our knowledge, the young patient showed only mild symptoms limited to skin rash.…”

“…It is possible that the young age (10) of the patient might be the reason why she suffered a mild disease despite her immune de ciency. Most of the reports of an effect of VZV on SLE/LN patients concerned older patients with herpes zoster 29,30 .The patient was diagnosed with SLE and LN at the age of 9 and was treated orally with 5mg glucocorticoid daily. After suffering from varicella, she was prescribed with proprietary Chinese medicine, Siji Antiviral Oral Liquid, Lysine Inosite and Vitamin B12 Oral Solution and treated with Acyclovir for external use.…”