Abstract
BackgroundThe association between herpes zoster and the risk of lymphoid neoplasms in Asian populations has not yet been established. We performed a longitudinal follow-up study using a nationwide cohort to assess the risk of lymphoid neoplasms arising after herpes zoster infection in the adult Korean population.MethodsData from participants ≥20 years of age who were registered in the Korean National Health Insurance Service-National Sample Cohort database between 2002 and 2013 were collected. We extracted the data of participants with herpes zoster (n = 59,495) as well as those of matched references at a ratio of 1:4 (n = 237,980) and investigated the subsequent occurrence of lymphoid neoplasms. A stratified Cox proportional hazards model was used to calculate unadjusted hazard ratios (HRs) as well as those adjusted for the Charlson comorbidity index score.ResultsThe rate of lymphoid neoplasms was higher in the herpes zoster group (0.15% [90/59,495]) than in the reference group (0.08% [212/237,980], P < 0.001). The unadjusted and adjusted HRs of herpes zoster in patients with lymphoid neoplasms were 1.68 (95% confidence interval [CI] = 1.31–2.15) and 1.58 (95% CI = 1.23–2.02), respectively (P < 0.001 for both). On subgroup analyses according to age and sex, herpes zoster was associated with an increased risk of lymphoid neoplasms in all subgroups; the adjusted HRs were 1.53 (95% CI = 1.05–2.24) for patients < 60 years old, 1.58 (95% CI = 1.14–2.20) for patients ≥60 years old, 1.64 (95% CI = 1.16–2.31) for men, and 1.51 (95% CI = 1.06–2.16) for women (P < 0.05 for all). On subgroup analysis of lymphoid neoplasm subtypes, herpes zoster was associated with the risk of Hodgkin’s disease (adjusted HR: 3.23 [95% CI = 1.17–8.93]) and multiple myeloma/malignant plasma cell neoplasms (adjusted HR: 2.17 [95% CI = 1.33–3.54]) (P < 0.05 for both).ConclusionHerpes zoster is associated with lymphoid neoplasm development in the Korean population irrespective of age and sex. The risks of Hodgkin’s disease and plasma cell neoplasms are significantly elevated in patients with herpes zoster.
Highlights
The association between herpes zoster and the risk of lymphoid neoplasms in Asian populations has not yet been established
The unadjusted and adjusted Hazard ratio (HR) of herpes zoster for lymphoid neoplasms were 1.68 and 1.58, respectively
On subgroup analyses according to age and sex, herpes zoster was associated with subsequent neoplasms in all subgroups (P < 0.05 for all, Table 3)
Summary
The association between herpes zoster and the risk of lymphoid neoplasms in Asian populations has not yet been established. We performed a longitudinal follow-up study using a nationwide cohort to assess the risk of lymphoid neoplasms arising after herpes zoster infection in the adult Korean population. Herpes zoster is a viral disease characterized by painful and pruritic vesicles in a dermatomal distribution [1, 2]. It is caused by the reactivation of latent varicella zoster virus infection, which is associated with a decline in cellmediated immunity [3,4,5]. As such, clarifying the association between herpes zoster and subsequent lymphoid neoplasms would be helpful in elucidating the pathogenesis of lymphoid neoplasms and facilitating their surveillance and early diagnosis
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