Background Severe herpes simplex virus (HSV) infections, especially encephalitis and keratitis, often affect immunocompromised patients and result in severe sequela. However, only few attempts have been made at the association between systemic lupus erythematosus (SLE) and HSV.
Objectives To identify the risk of severe HSV infection in SLE patients by means of a nationwide population-based cohort study.
Methods We identified SLE patients from the National Health Insurance research database between 1997 and 2012. We compared the incidence rate (IR) of severe HSV infection, including viral septicaemia, CNS infection, ocular infection, visceral infection and those with complications after infection, with that of non-SLE cohort. A Cox multivariable proportional hazards model was applied to evaluate the risk of severe HSV infection in the SLE cohort.
Results A total of 122,520 subjects (24,504 SLE patients and 98,016 age- and gender-matched subjects as control group) were analyzed and revealed a significantly higher IR of severe HSV infection in SLE (Incidence rate ratio =3.52, p <0.001). Previous skin infection (HR=2.17, p=0.047), intravenous steroid pulse therapy (HR=4.48, p<0.001), oral daily steroid dose over 7.5mg prednisolone or equivalent (HR=1,60, p=0.010) were independent risk factors for severe HSV infection in SLE patients, while Age ≤18 (Hazard ratio [HR]=0.47, p=0.021) was a protective factor.
Conclusions A higher risk of severe HSV infection was observed in SLE patients Risk factors for severe HSV infection were age over 18, previous skin infection, intravenous steroid pulse therapy and an oral daily steroid dose over 7.5mg.
Infection risk in systemic lupus erythematosus patients: susceptibility factors and preventive strategies. Lupus. 2013 Oct;22(12):1286–94
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Disclosure of Interest None declared