Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan.
Center for Senile Degenerative Disorders (CSDD), Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan.
Biomolecules. 2024 Jun 22;14(7):739. doi: 10.3390/biom14070739.
The varicella-zoster virus (VZV) is a human neurotropic herpes virus responsible for varicella and herpes zoster (HZ). Following primary infection in childhood, VZV manifests as varicella (chickenpox) and enters a period of latency within the dorsal root ganglion. A compromised cellular immune response due to aging or immunosuppression triggers viral reactivation and the development of HZ (shingles). Patients with autoimmune diseases have a higher risk of developing HZ owing to the immunodeficiency associated with the disease itself and/or the use of immunosuppressive agents. The introduction of new immunosuppressive agents with unique mechanisms has expanded the treatment options for autoimmune diseases but has also increased the risk of HZ. Specifically, Janus kinase (JAK) inhibitors and anifrolumab have raised concerns regarding HZ. Despite treatment advances, a substantial number of patients suffer from complications such as postherpetic neuralgia for prolonged periods. The adjuvanted recombinant zoster vaccine (RZV) is considered safe and effective even in immunocompromised patients. The widespread adoption of RZV may reduce the health and socioeconomic burdens of HZ patients. This review covers the link between VZV and autoimmune diseases, assesses the risk of HZ associated with immunosuppressant use, and discusses the benefits and risks of using RZV in patients with autoimmune diseases.
水痘-带状疱疹病毒（VZV）是一种人类嗜神经疱疹病毒，可引起水痘和带状疱疹（HZ）。初次感染后，VZV 会引发水痘（水痘），并在背根神经节进入潜伏期。由于衰老或免疫抑制导致细胞免疫反应受损，会触发病毒重新激活和 HZ（带状疱疹）的发展。由于疾病本身和/或免疫抑制药物的使用导致免疫缺陷，自身免疫性疾病患者发生 HZ 的风险更高。具有独特作用机制的新型免疫抑制剂的引入扩大了自身免疫性疾病的治疗选择，但也增加了 HZ 的风险。具体来说，Janus 激酶（JAK）抑制剂和 anifrolumab 引起了对 HZ 的关注。尽管治疗取得了进展，但仍有相当数量的患者长期遭受带状疱疹后神经痛等并发症的困扰。佐剂重组带状疱疹疫苗（RZV）即使在免疫功能低下的患者中也被认为是安全有效的。RZV 的广泛应用可能会降低 HZ 患者的健康和社会经济负担。本文综述了 VZV 与自身免疫性疾病之间的联系，评估了与免疫抑制药物使用相关的 HZ 风险，并讨论了 RZV 在自身免疫性疾病患者中的应用的获益和风险。
