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Meta-Analysis
. 2023 May:130:108-125.
doi: 10.1016/j.ijid.2023.01.036. Epub 2023 Feb 1.

Systematic review with meta-analysis of active herpesvirus infections in patients with COVID-19: Old players on the new field

Ana Banko  1 , Danijela Miljanovic  2 , Andja Cirkovic  3
Affiliations
Meta-Analysis

Systematic review with meta-analysis of active herpesvirus infections in patients with COVID-19: Old players on the new field

Ana Banko et al. Int J Infect Dis. 2023 May.

Abstract

Objectives: Herpesviruses are ubiquitous and after primary infection they establish lifelong latency. The impairment of maintaining latency with short-term or long-term consequences could be triggered by other infection. Therefore, reactivation of herpesviruses in COVID-19 patients represents an emerging issue.

Design and methods: This study provided the first systematic review with meta-analysis of studies that evaluated active human herpesvirus (HHV) infection (defined as the presence of IgM antibodies or HHV-DNA) in COVID-19 patients and included 36 publications collected by searching through PubMed, SCOPUS, and Web of science until November 2022.

Results: The prevalence of active EBV, HHV6, HSV, CMV, HSV1, and VZV infection in COVID-19 population was 41% (95% CI =27%-57%), 3% (95% CI=17%-54%), 28% (95% CI=1%-85%), 25% (95% CI=1%-63%), 22% (95% CI=10%-35%), and 18% (95% CI=4%-34%), respectively. There was a 6 times higher chance for active EBV infection in patients with severe COVID-19 than in non-COVID-19 controls (OR=6.45, 95% CI=1.09-38.13, p=0.040), although there was no difference in the prevalence of all evaluated active herpesvirus infections between COVID-19 patients and non-COVID-19 controls.

Conclusions: Future research of herpesvirus and SARS-CoV-2 coinfections must be prioritized to define: who, when and how to be tested, as well as how to effectively treat HHVs reactivations in acute and long COVID-19 patients.

Keywords: CMV; COVID-19; EBV; HSV; SARS-CoV-2 infection; VZV.

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Conflict of interest statement

Declarations of competing interest The authors have no competing interests to declare.

Figures

Image, graphical abstract
Graphical abstract
Figure 1
Figure 1
Flow diagram.
Figure 2
Figure 2
Meta-analysis of the prevalence of active Epstein-Barr virus infection in COVID-19 population. CI, confidence interval; IV, inverse variance; SE, standard error.
Figure 3
Figure 3
Meta-analysis of the prevalence of active human herpesvirus 6 infection in COVID-19 population. CI, confidence interval; IV, inverse variance; SE, standard error.
Figure 4
Figure 4
Meta-analysis of the prevalence of active herpes simplex virus infection in COVID-19 population. CI, confidence interval; IV, inverse variance; SE, standard error.
Figure 5
Figure 5
Meta-analysis of the prevalence of active cytomegalovirus infection in COVID-19 population. CI, confidence interval; IV, inverse variance; SE, standard error.
Figure 6
Figure 6
Meta-analysis of the prevalence of active varicella zoster virus infection in COVID-19 population. CI, confidence interval; IV, inverse variance; SE, standard error.
Figure 7
Figure 7
Meta-analysis of the prevalence of active herpes simplex virus type 1 infection in COVID-19 population. CI, confidence interval; IV, inverse variance; SE, standard error.
Figure 8
Figure 8
Forest plot of the difference in the prevalence of active Epstein-Barr virus infection in severe COVID-19 population in comparison with non-COVID-19 control group. CI, confidence interval; IV, inverse variance; SE, standard error.
See this image and copyright information in PMC

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