SYSTEMATIC REVIEW article

Front. Immunol.

Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders

Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1544218

This article is part of the Research TopicHerpesviruses: Pathogenesis and Host InteractionsView all 7 articles

Prevalence, incidence, and risk factors for herpes zoster in systemic lupus erythematosus: A Systematic Review and Meta-Analysis

Provisionally accepted
  • 1Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Jiangsu Province, China
  • 2First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
  • 3Department of Rheumatology and Immunology, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Jiangsu Province, China
  • 4Center of Clinical Evaluation and Analysis, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Jiangsu Province, China

The final, formatted version of the article will be published soon.

Background: Patients with systemic lupus erythematosus (SLE) are particularly vulnerable to infections, with herpes zoster (HZ) being the most common opportunistic infection. This meta-analysis aimed to systematically review the available literature on the prevalence, incidence, and risk factors of HZ in SLE patients. Methods: A comprehensive search through Embase, PubMed, Web of Science, and Cochrane Library was conducted for studies published up to November 1, 2024. Both observational studies (including cohort, case-control, and cross-sectional) and randomized controlled trials (RCTs) were included, with study types selected according to the specific objectives. Funnel plots and Egger's test were employed to assess publication bias. Hazard ratios (HRs) and odds ratios (ORs) were converted to relative risks (RRs), and pooled estimates were calculated using a fixed-effect or random-effects model. Results: A total of 51 studies with 246, 822 SLE patients were included in this meta-analysis. The pooled prevalence and incidence of SLE-HZ were 12.3% (95%CI 10.5-14.1) and 22.0 cases per 1000 person-years (95%CI 17.4-27.9). Glucocorticoids use (RRs=2.83, 95%CI 2.10-3.81), cyclophosphamide use (RRs=2.52, 95%CI 1.60-3.98), mycophenolate mofetil use (RRs=3.00, 95%CI 1.07-8.40), azathioprine use (RRs=1.40, 95%CI 1.18-1.67), anifrolumab use (RRs=2.59, 95%CI 1.52-4.41), having lymphopenia (RRs=2.31, 95%CI 1.54-3.46), and the presence of comorbid conditions such as renal involvement (RRs= 1.80, 95%CI 1.34-2.42) were identified to increase the risk of HZ in SLE patients. Conclusion: The existing evidence highlights the both high prevalence and incidence of HZ in SLE patients. By identifying risk factors associated with the development of HZ in SLE patients, optimization of management strategies and treatment choices can be achieved. Concurrently, physicians could be better equipped to choose patients who would most likely gain from the HZ vaccine.

Keywords: systemic lupus erythematosus, Herpes Zoster, Incidence, Prevalence, risk factor

Received: 12 Dec 2024; Accepted: 10 Jul 2025.

Copyright: © 2025 Wang, Gao, Lin, Liu, Cao and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Yi Cao, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Jiangsu Province, China
Qiu-Shuang Li, Center of Clinical Evaluation and Analysis, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Jiangsu Province, China

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