Study Investigates Risk of Herpes Simplex Virus (HSV) Infections in Patients with Systemic Lupus Erythematosus (SLE)

A recent study headed by researchers at Columbia University Medical Center (CUMC) sought to identify the risk of herpes simplex virus (HSV) infections in patients with systemic lupus erythematosus (SLE).

Led by Dr. Teja Kapoor of the CUMC Division of Rheumatology, the study evaluated data from 2013 electronic medical records (EMR) of patients with an SLE diagnosis from the CUMC Clinical Data Warehouse. Researchers were able to identify 59 patients that developed complicated zoster infections. This included 10 incidents of disseminated zoster, with one death. The records also revealed that from the 129 HSV cases identified, there was one case of HSV meningitis, 5 ophthalmic HSV infections, 56 patients suffering from oral and/or genital ulcers, and 67 patients with unspecified HSV infections.

Immunocompromised patients carry a high risk for herpes simplex virus and varicella zoster virus (VZV) infections. For example, patients with SLE are 70 percent more likely to develop shingles (herpes zoster) compared to the general population, according to the Lupus Foundation of America. The use of certain medications such prednisone or mycophenolate mofetil can further increase this risk. But even with this increased susceptibility, lupus patients have surprisingly low vaccination rates, possibly due to a lack of awareness concerning the vaccine’s availability, its cost, or concerns about safety for people with lupus.

While the study’s results were not enough to necessarily support the recommendation of prophylactic use of antiviral treatment in SLE patients, the findings did further substantiate the need for VZV vaccination, and for establishing a low threshold for antiviral treatment.

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Lupus