Cytomegalovirus seropositivity is associated with herpes zoster

Abstract

Herpes zoster (HZ) is caused by VZV reactivation that is facilitated by a declined immunity against varicella-zoster virus (VZV), but also occurs in immunocompetent individuals. Cytomegalovirus (CMV) infection is associated with immunosenescence meaning that VZV-specific T-cells could be less responsive. This study aimed to determine whether CMV infection could be a risk factor for the development of HZ. CMV IgG serostatus was determined in stored serum samples from previously prospectively recruited ambulatory adult HZ patients in the UK (N = 223) in order to compare the results with those from UK population samples (N = 1545) by means of a logistic regression (controlling for age and gender). Furthermore, we compared the UK population CMV seroprevalence with those from population samples from other countries (from Belgium (N1 = 1741, N2 = 576), USA (N = 5572) and Australia (N = 2080)). Furthermore, CMV IgG titers could be compared between UK HZ patients and Belgium N2 population samples because the same experimental set-up for analysis was used. We found UK ambulatory HZ patients to have a higher CMV seroprevalence than UK population samples (OR 1.56 [1.11 2.19]). CMV IgG seropositivity was a significant risk factor for HZ in the UK (OR 3.06 [1.32 7.04]. Furthermore, high CMV IgG titers (exceeding the upper threshold) were less abundant in CMV-seropositive Belgian N2 population samples than in CMV-seropositive UK HZ patients (OR 0.51 [0.31 0.82]. We found CMV-seroprevalence to increase faster with age in the UK than in other countries (P < 0.05). We conclude that CMV IgG seropositivity is associated with HZ. This finding could add to the growing list of risk factors for HZ.

Keywords: CMV; immunosenescence; reactivation; shingles; susceptibility; zoster.

Figure 1.

Observed and predicted CMV-seroprevalence percentage for UK HZ patient and UK general population samples. Caption: Groups are classified using age (50 years as cut-off), gender, data set (UK HZ (HZ) or UK-reference (UK)). The number of participants per classification group is shown (N). For each classification group the left column shows the observed CMV-seroprevalence whereas the right column shows the CMV-seroprevalence as predicted by the logistic regression analysis.

Figure 2.

Observed CMV-seroprevalence for UK reference sample (‘UK’), BE-2002 population sample (‘BE-2002’), USA population sample (‘USA’) and Australian population sample (‘AUS’). Caption: raw observed data are shown for women in upper panel and for men in lower panel.

Figure 2.

Observed CMV-seroprevalence for UK reference sample (‘UK’), BE-2002 population sample (‘BE-2002’), USA population sample (‘USA’) and Australian population sample (‘AUS’). Caption: raw observed data are shown for women in upper panel and for men in lower panel.