Título: "Herpes Zoster and the Risk for Stroke
in Patients with Autoimmune Diseases"
Autores: Calabrese LH, Xie F, Yun H, Winthrop K,
Baddley JW, Calabrese C, Curtis, JR.
Arthritis & Rheumatology
DOI 10.1002/art. 39855
Background: Herpes zoster (HZ) is an opportunistic infection caused by varicella zoster virus (VZV), and observed with increasing frequency in patients on immunosuppressive therapies. Prior literature has suggested that the risk of stroke may increase shortly after herpes zoster, but little is known about this association for patients with autoimmune (AI) diseases, who are at increased risk both for zoster and stroke.
Methods: Medicare data (2006-2013) was used to identify patients with autoimmune diseases. The outcome of interest was hospitalized stroke. The hypothesis tested was that the incidence of stroke immediately following HZ was increased compared to the incidence of stroke at later time points. Secondary analysis included assessmen
t of the impact of antiviral therapy on subsequent stroke as well as the influence of VZV-related complications on stroke incidence.
Results: The crude incidence of stroke ranged from a high of 2.30 (0.96-5.52) per 100 patient years within 90 days of HZ in patients who had HZ-related cranial nerve complications and did not receive treatment to a low of 0.87 (0.75-1.02) per 100py (>1 year after uncomplicated HZ). After multivariable adjustment for multiple stroke-related factors, the incidence rate ratio (IRR) for stroke in the first 90 days after HZ was 1.36 (1.10-1.68) compared to stroke >1 year after HZ. The risk was greater for patients with zoster with cranial nerve complications (IRR 2.08, 95%CI 0.99-4.36). Prompt antiviral therapy was associated with lower incidence of subsequent stroke (IRR 0.83, 95% CI 0.70- 0.98).
Conclusion: In patients with autoimmune diseases, incident HZ was associated with up to a two-fold increased risk for stroke in the subsequent few months. These data provide urgency for developing strategies to reduce the risk of VZV.