Korean J Intern Med.  2021 Jul;36(4):992-1000. 10.3904/kjim.2020.672.

Varicella zoster virus (VZV)-specific immunity and subclinical VZV reactivation in patients with autoimmune diseases

• Lee KH
• Choi S
• Kwon JS
• Kim SH
• Park SY

• KMID: 2517816
• DOI: http://doi.org/10.3904/kjim.2020.672

Abstract

Background/Aims
The risk of herpes zoster (HZ) is increased in patients with autoimmune diseases (AID), probably due to immunosuppressive therapy.
Methods
This prospective cross-sectional study investigated varicella zoster virus (VZV)-specific immunity in relation to subclinical VZV reactivation in 48 AID patients and 48 healthy controls (HCs). We assessed humoral immunity (serum VZV immunoglobulin g [IgG], IgA, and IgM) and cell-mediated immunity (interferon-γ [IFNγ]-releasing assay) to VZV as well as salivary VZV DNA status. Subclinical VZV reactivation was confirmed by detecting VZV DNA in saliva or VZV IgM in serum in the absence of typical HZ symptoms.
Results
Median IgA levels were higher in the AID group than in the HC group, while VZV IgG and IgM levels were comparable between the groups. AID patients showed fewer IFNγ spot-forming cells (SFCs) upon VZV stimulation than HCs (58.2 vs. 122.0 SFCs/10⁶ peripheral blood mononuclear cells [PBMCs], p < 0.0001). Subclinical VZV reactivation was more frequent in AID patients than in HCs (12.5% vs. 0%, p = 0.01). AID patients with VZV reactivation received prednisolone more frequently and at a higher dose than AID patients without reactivation. VZV-specific IFNγ SFCs were significantly lower in patients with VZV reactivation among AID patients (26.3 vs. 62.6 SFCs/10⁶ PBMCs, p < 0.0001).
Conclusions
Results suggest that poor cellular response against VZV might cause clinical and subclinical reactivation of VZV in AID patients.

Keyword

Varicella zoster virus; Autoimmune diseases; Subclinical reactivation; Immunity, cellular