Risk factors for cytomegalovirus reactivation and disease in patients with systemic lupus erythematosus

Abstract

Objectives

To clarify risk factors for cytomegalovirus (CMV) reactivation and disease in patients with systemic lupus erythematosus (SLE).

Methods

We reviewed patients with SLE who received remission induction therapy at our institution between May 2010 and October 2022 and enrolled those whose CMV pp65 antigen–positive cell counts were measured within 3 months of admission. Patients with CMV reactivation were divided into CMV disease (with any symptoms or end-organ disease due to CMV reactivation) and asymptomatic CMV reactivation. Risk factors for CMV reactivation and CMV disease were examined.

Results

We observed CMV reactivation in 64 of 130 patients. Age (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.09–3.78; p = 0.026), albumin (HR, 2.35; 95% CI, 1.09–5.07; p = 0.029), a high Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) (HR, 1.73; 95% CI, 1.00–2.98; p = .048), and immunosuppressive drug use (HR, 1.94; 95% CI, 1.12–3.35; p = 0.018) were risk factors for CMV reactivation. CMV reactivation occurred more frequently when two or more risk factors were present. Among the 64 cases of CMV reactivation, 25 with disease had a higher number of CMV pp65 antigen–positive cells (6 vs 2; p = 0.02). The cut-off value for developing organ damage was 12 cells on two slides.

Conclusion

In SLE patients, age, albumin, a high SLEDAI, and immunosuppressive drug use were possible risk factors for CMV reactivation. Patients who develop organ damage have high numbers of CMV pp65 antigen–positive cells and are prone to be symptomatic with an antigenemia count >12 per two slides.